Blue Advantage Plan described as national Medicare Advantage option with mostly $0 copays
May 13, 2024 | Acadia Parish, School Boards, Louisiana
This article was created by AI summarizing key points discussed. AI makes mistakes, so for full details and context, please refer to the video of the full meeting. Please report any errors so we can fix them. Report an error »
A presenter described the Blue Advantage Medicare Advantage plan as a group product designed with the school board that lets members use providers across the United States and that covers most medical services with no copays.
The presenter said the plan is a national PPO that accepts any provider that takes Medicare and that "everything associated with this plan on the medical side has 0 co pays." He added that if an emergency-room visit is judged non-emergency, the visit carries a $50 copay, but that copay is waived if the member is admitted to the hospital within 72 hours of the ER visit.
The plan’s prescription coverage is tiered. The presenter said generic medications are available as a 90-day supply with a $0 copay, while a typical brand-tier copay was described as $45. Specialty drugs were described as placed on a specialty tier and "capped at a $100." The presenter used Humira as an example of a high-cost medicine, saying it can cost about $7,400 a month and that under the plan the member’s out-of-pocket would be limited to the specialty cap.
Beyond medical and drug coverage, the presenter said the plan includes supplemental benefits commonly not found on original Medicare: a $2,000 dental benefit for crowns and dentures, a $300 vision allowance for glasses or contacts, $1,100 toward hearing aids, a free gym membership at participating locations and $100 per quarter for over-the-counter items.
Administration-wise, the presenter said members will receive a single Blue Cross card to present for services and must maintain Medicare Parts A and B to remain enrolled; dropping Part B would end eligibility for the plan. The presenter explained that providers will bill Blue Cross, which pays the bill and is reimbursed by Medicare for the Medicare-covered portion, and that Medicare’s subsidies for drug costs and the 80% Medicare funding share help lower the premium the school board would pay on behalf of members.
The presenter offered to take questions at the end of the session.
The presenter said the plan is a national PPO that accepts any provider that takes Medicare and that "everything associated with this plan on the medical side has 0 co pays." He added that if an emergency-room visit is judged non-emergency, the visit carries a $50 copay, but that copay is waived if the member is admitted to the hospital within 72 hours of the ER visit.
The plan’s prescription coverage is tiered. The presenter said generic medications are available as a 90-day supply with a $0 copay, while a typical brand-tier copay was described as $45. Specialty drugs were described as placed on a specialty tier and "capped at a $100." The presenter used Humira as an example of a high-cost medicine, saying it can cost about $7,400 a month and that under the plan the member’s out-of-pocket would be limited to the specialty cap.
Beyond medical and drug coverage, the presenter said the plan includes supplemental benefits commonly not found on original Medicare: a $2,000 dental benefit for crowns and dentures, a $300 vision allowance for glasses or contacts, $1,100 toward hearing aids, a free gym membership at participating locations and $100 per quarter for over-the-counter items.
Administration-wise, the presenter said members will receive a single Blue Cross card to present for services and must maintain Medicare Parts A and B to remain enrolled; dropping Part B would end eligibility for the plan. The presenter explained that providers will bill Blue Cross, which pays the bill and is reimbursed by Medicare for the Medicare-covered portion, and that Medicare’s subsidies for drug costs and the 80% Medicare funding share help lower the premium the school board would pay on behalf of members.
The presenter offered to take questions at the end of the session.
View the Full Meeting & All Its Details
This article offers just a summary. Unlock complete video, transcripts, and insights as a Founder Member.
✓
Watch full, unedited meeting videos
✓
Search every word spoken in unlimited transcripts
✓
AI summaries & real-time alerts (all government levels)
✓
Permanent access to expanding government content
30-day money-back guarantee
