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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 $57.00. 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 $5500.00 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 type. For preferred generic drugs, you will pay a $12 copay at preferred pharmacies and a $18 copay at standard pharmacies. Preferred 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 wide range of benefits with varying costs. Hospital stays have a copay of $295 for the first week, and then no copay for the remainder of the stay. Outpatient, primary care, vision, and dental services offer many services with no copay, while others have copays ranging from $20 to $125. This plan includes coverage for emergency services with a $125 copay, and covers prescription hearing aids up to $800 per year with no copay. The plan also covers home health and skilled nursing facility services, with no copay for the first 20 days of a skilled nursing facility stay. Many other services are covered, including home infusion, dialysis, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by the Blue adVantage Giveback (HMO-POS) plan. For days 1-7, there is a $295 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a $295 copay, and ambulatory surgical center services with no copay. This plan also covers outpatient substance abuse services including individual and group sessions with a $40 copay, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue adVantage Giveback (HMO-POS) plan. This benefit has a $60 copay.
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; both have no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Blue adVantage Giveback (HMO-POS) plan, with a $125 copay and no coinsurance; Urgently Needed Services have a $50 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay, but 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 with a $20 copay, and occupational therapy services with a $35 copay. Physician specialist services have a $50 copay, while mental health and psychiatric individual and group sessions have a $40 copay. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $50. Other health care professional services have a coinsurance of 20% and a copay between $0 and $50. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered by this plan. However, 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Blue adVantage Giveback (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $800 per year with no copay, while OTC hearing aids have no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Blue adVantage Giveback (HMO-POS) plan covers vision services, including eye exams with a $50 copay, and routine eye exams with no copay. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, with a combined maximum benefit of $250 per year.
Dental Services See details
Dental Services are covered under the Blue adVantage Giveback (HMO-POS) plan, with a maximum benefit of $2,200 every year. Many dental services have no copay, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, implant services, prosthodontics, fixed, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Blue adVantage Giveback (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue adVantage Giveback (HMO-POS) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $30, and lab services with no copay. Radiological services are covered, including diagnostic radiological services with a copay up to $250, therapeutic radiological services with a 20% coinsurance, and outpatient X-ray services with up to 20% coinsurance.
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 by the Blue adVantage Giveback (HMO-POS) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Blue adVantage Giveback (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, while days 21-100 have a $200 copay. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, but does not cover 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. This plan offers OTC items as a supplemental benefit.
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