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Blue adVantage Platinum (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Platinum (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue adVantage Platinum (HMO-POS) in 2026, please refer to our full plan details page.
Blue adVantage Platinum (HMO-POS) is a HMO-POS plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in State of Louisiana. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Blue adVantage Platinum (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue adVantage Platinum (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue adVantage Platinum (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $222.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue adVantage Platinum (HMO-POS) plan features an annual drug deductible of $300. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. For Tier 2 generic medications, copays start as low as $12 for a one-month supply at preferred locations. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply at preferred pharmacies and mail-order services. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply. Choosing standard pharmacies or standard mail-order services across all tiers will result in slightly higher copayments.
Additional Benefits
The Blue adVantage Platinum (HMO-POS) plan offers comprehensive medical coverage with no coinsurance for many core services, including primary care visits, which have no copay, and specialist visits with a $25 copay. Inpatient hospital stays require a daily copay of $205 for the first seven days of acute care, while emergency room visits carry a $125 copay that is waived if you are admitted. Outpatient hospital services range from no copay to a $150 copay, helping to keep your medical costs predictable. This plan also features strong supplemental benefits, including no copay and no coinsurance for routine vision exams, routine hearing services, and preventive dental care up to a $2,700 annual limit. Additionally, over-the-counter items and the first 20 days of skilled nursing facility stays require no copay or coinsurance. For durable medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue adVantage Platinum (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a daily copay of $205 for days 1 to 7 of acute stays and $225 for days 1 to 7 of psychiatric stays, followed by no copay for days 8 to 90. This benefit is partially covered, as additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue adVantage Platinum (HMO-POS) covers outpatient hospital services with a $0 to $150 copay and observation services with a $205 daily copay, both with no coinsurance. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions have a $20 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue adVantage Platinum (HMO-POS) plan with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Blue adVantage Platinum (HMO-POS) covers ambulance services with no coinsurance, requiring a $250 copay for ground ambulance services and a $260 copay for air ambulance services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under Blue adVantage Platinum (HMO-POS) are covered with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency services are partially covered with a $125 copay and no coinsurance, but worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Blue adVantage Platinum (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Blue adVantage Platinum (HMO-POS) partially covers preventive services with no copay and no coinsurance for covered benefits such as annual physical exams and kidney disease education. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Blue adVantage Platinum (HMO-POS) with no copay and no coinsurance for routine exams, fittings, and over-the-counter hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance up to a maximum of $800 every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Blue adVantage Platinum (HMO-POS) features partially covered vision services with no coinsurance, though other eye exam services are not covered. Routine eye exams and eyewear have no copay, other covered eye exams require a $25 copay, and there is a $200 annual maximum benefit for eyewear.
Dental Services See details
Blue adVantage Platinum (HMO-POS) dental services are partially covered with no copay and no coinsurance up to a $2,700 annual maximum. While preventive, diagnostic, restorative, and surgical services are covered, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue adVantage Platinum (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Blue adVantage Platinum (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Blue adVantage Platinum (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Blue adVantage Platinum (HMO-POS) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $30 copay for diagnostic procedures. Radiological services require prior authorization and feature a minimum 20% coinsurance plus a copay for therapeutic services, alongside coinsurance (starting at no coinsurance for X-rays) and a minimum $0 copay for diagnostic radiological services.
Home Health Services See details
Blue adVantage Platinum (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue adVantage Platinum (HMO-POS) covers some Cardiac Rehabilitation Services with no coinsurance and prior authorization required. However, standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue adVantage Platinum (HMO-POS) with no coinsurance, though prior authorization and a prior three-day inpatient hospital stay are required. There is no copay for days 1 through 20, followed by a $200 daily copay for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
Blue adVantage Platinum (HMO-POS) provides partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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