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Blue adVantage Giveback (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Giveback (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 Giveback (HMO-POS) in 2025, please refer to our full plan details page.
Blue adVantage Giveback (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 Giveback (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 Giveback (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 Giveback (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $70.00. You must continue to pay paying your reduced 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 $195.00 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 $6500.00 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 Giveback (HMO-POS) plan has a $195 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $12 copay at a preferred pharmacy, while standard generic drugs have a $45 copay. Preferred and standard brand drugs have a 50% coinsurance, and non-preferred drugs have a 29% coinsurance.
Additional Benefits
The Blue adVantage Giveback (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $295 copay for days 1-7 and no copay for days 8-90, as well as outpatient services with varying copays. This plan provides coverage for primary care with no copay, and also covers hearing and vision services, including hearing exams, routine eye exams, and eyewear with no copay. Dental services are also covered. This plan offers additional benefits such as ambulance services, emergency services, and home health services with no copay. The plan also covers prescription hearing aids and other services like home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Blue adVantage Giveback (HMO-POS) plan. You will pay a $295 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a copay ranging from $0 to $300 for outpatient hospital services, and $295 per day for observation services. Ambulatory Surgical Center (ASC) Services are covered with no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue adVantage Giveback (HMO-POS) plan, and requires prior authorization. You will have a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue adVantage Giveback (HMO-POS) plan. Ground ambulance services have a $250 copay, while air ambulance services have a $300 copay, and both have no coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue adVantage Giveback (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $50 copay; there is no coinsurance for these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue adVantage Giveback (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $35 copay. Physician specialist services have a $50 copay, while mental health and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay. Other health care professional services have a copay between $0 and $50, with 20% coinsurance. Additional telehealth benefits range from no copay to a $50 copay, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services, but do not include Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services. This plan also covers Home-Based Palliative Care and Fitness Benefit.
Hearing Services See details
The Blue adVantage Giveback (HMO-POS) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, as well as OTC hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $800 per year, with no copay for all types of prescription hearing aids.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a $50 copay, and routine eye exams have no copay. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, but eyewear has a combined maximum benefit of $200 every year.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with no copay. Other Dental Services has a maximum benefit of $2,200 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments have no copay, with limitations on the number of visits and periodicity. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Blue adVantage Giveback (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment, though Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, and require prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Blue adVantage Giveback (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue adVantage Giveback (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $200 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are partially covered by the Blue adVantage Giveback (HMO-POS) plan, with acupuncture, meal benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services not covered. Over-the-counter items are covered.
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