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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 2025, 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 3.5 out of 5 stars in 2025.
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 $207.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $12 copay at preferred pharmacies and 50% coinsurance for preferred brand drugs. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The Blue adVantage Platinum (HMO-POS) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a copay depending on the length of stay, while outpatient services can range from no copay to $150. Emergency and urgent care services have copays, and primary care, preventive, hearing, vision, and dental services often have no copay. This plan includes coverage for ambulance services with copays, and services like home health and skilled nursing facilities. Diagnostic and radiological services have copays or coinsurance, and durable medical equipment is covered with coinsurance. The plan also offers benefits for home infusion, dialysis, and other services, with specific copays or coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $205 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute and a copay of $225 per day for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services with a $205 copay per day. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $20 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue adVantage Platinum (HMO-POS) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for any services. Ground Ambulance Services have a $250 copay, and Air Ambulance Services have a $260 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Blue adVantage Platinum (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $125 copay, with no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue adVantage Platinum (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $25 copay, mental health specialty services with a $20 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $35 copay. Additional telehealth benefits are covered with a copay between $0 and $35, and opioid treatment program services have a $40 copay.
Preventive Services See details
The Blue adVantage Platinum (HMO-POS) plan covers preventive services including Medicare-covered services, annual physical exams, and additional services such as Home-Based Palliative Care, Kidney Disease Education Services, Glaucoma Screenings, and Diabetes Self-Management Training, with no copay. However, services like Health Education, In-Home Safety Assessments, and others are not covered.
Hearing Services See details
Hearing Services are covered, including hearing exams with no copay, routine hearing exams (1 per year) with no copay, and fitting/evaluation for hearing aids (1 per year) with no copay. Prescription Hearing Aids are covered, with a maximum benefit of $1100 per year, but the plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, or Prescription Hearing Aids - Over the Ear. OTC Hearing Aids are also covered with no copay.
Vision Services See details
Vision services include eye exams with a $25 copay, and eyewear with no copay. Routine eye exams, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay. Contact lenses have a $0 copay.
Dental Services See details
The Blue adVantage Platinum (HMO-POS) plan covers a range of dental services with no copay, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. However, the plan does not cover maxillofacial prosthetics or orthodontics. There is a maximum plan benefit of $2700 per year for other dental services.
Home Infusion bundled Services See details
The Blue adVantage Platinum (HMO-POS) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Blue adVantage Platinum (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment with no copay and coinsurance, but the plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The Blue adVantage Platinum (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $30, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $125, while Therapeutic Radiological and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Blue adVantage Platinum (HMO-POS) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue adVantage Platinum (HMO-POS) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue adVantage Platinum (HMO-POS) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $165.
Other Services See details
The Blue adVantage Platinum (HMO-POS) plan does not cover acupuncture, meal benefits, or dual eligible SNPs with highly integrated services. Over-the-counter items are covered, but the plan does not cover all drugs on the CMS OTC list. All other services are not covered.
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