|Part D Benefit:||Yes|
|Rx Gap Coverage:||Y|
Blue Medicare HMO Enhanced is a Health Maintenance Organization (HMO) Medicare Advantage plan, by Blue Cross and Blue Shield of North Carolina, available in Greene County, North Carolina. It offers all of the basic benefits of Original Medicare and may include additional coverage.
With an HMO plan, like this one from Blue Cross and Blue Shield of North Carolina, your out-of-pocket costs are much lower than Original Medicare. That's the big advantage.
IMPORTANT: You must use providers in the Blue Cross and Blue Shield of North Carolina network to avoid incurring additional costs. You are responsible for all costs incurred out of network. Referrals are generally required to see specialists.
The monthly premium for this plan in Greene County, NC is $110.40. This amount is paid directly to Blue Cross and Blue Shield of North Carolina.
If you enroll in this plan you will pay your Medicare Part B premium plus this plan's monthly premium. Most people pay the standard Part B premium, but some beneficiaries pay higher Part B premiums due to their annual income (over $85k for singles or $170k for married couples). Late enrollment penalties can also increase your Part B premium.
What you pay in premiums is independent of the health care services you use. You also have copayments and/or coinsurances (cost sharing) that you pay out of pocket when you use health care services or fill prescriptions.
Maximum Out-of-Pocket Limit
All 2018 Medicare Advantage plans have a $6,700 maximum out-of-pocket (MOOP) limit. That said, Medicare allows for a voluntary MOOP as low as $3,400.This plan's MOOP is $5,500. This figure is not inclusive of your monthly premium or the cost of your prescriptions (Medicare Part D Coverage).
This means that you will no longer pay copayment or coinsurance as soon as your copayments and coinsurance for doctor visits and hospital care reaches $5,500. This is your guarantee that an illness or accident will send you into bankruptcy. Consider the MOOP along with the premium and the copay.
If you're comparing this plan with Original Medicare, don't forget that you pay about 20% of all covered expenses, but there's no limit. You have a lot of risk with Original Medicare unless you buy a Medicare Supplement to cover your copayments and coinsurances.
Coverage, Copayments & Coinsurance
The Blue Medicare HMO Enhanced plan offers the same basic benefits as Original Medicare. The big difference is copayments and coinsurances. Below you will find (where available) what you will pay for common health care services.
Most plans have copayments when you see your primary care doctor or a specialist. Here's how this plan works:
|Primary Care Doctor:||$5 co-payment|
|Physician Specialist:||$40 co-payment|
|Occupational Therapist:||$40 co-payment|
|Physical Therapist:||$40 co-payment|
|Speech Terapist:||$40 co-payment|
If you are admitted to a hospital or clinic for treatment and stay overnight, you are an inpatient. Most plans have tiered costs for inpatient treatment. Here's how this plan covers you:
- Day 1 to 6: $300
- Day 7 to 90: $0
The following preventative healthcare services are covered at no cost:
- Abdominal aortic aneurysm screening
- Alcohol misuse counseling
- Bone mass measurement
- Breast cancer screening (mammogram)
- Cardiovascular disease (behavioral therapy)
- Cardiovascular screenings
- Cervical and vaginal cancer screening
- Colorectal cancer screenings
- Depression screening
- Diabetes screenings
- HIV screening
- Medical nutrition therapy services
- Obesity screening and counseling
- Prostate cancer screenings (PSA)
- Sexually transmitted infections screening and counseling
- Tobacco use cessation counseling
- Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
- Welcome to Medicare preventive visit
- Yearly Wellness visit
Prescription Drug Coverage
This plan includes Medicare Part D coverage for your prescription medications. The table below outlines what you will pay (the copayment) at your pharmacy for medications at each tier level.
|6||Select Care Drugs||$1|
|6||Select Care Drugs||$1|
If you are entitled to Part D assistance, your premium will be adjusted based on your percentage.
The Part D deductible on this plan is $0.00 (first dollar coverage).
Medicare Plan Rating
Medicare gave the Blue Medicare HMO Enhanced plan an average rating of -1.0 out of 5 stars. This rating is , by Medicare's definition.
Medicare evaluates the quality of all Medicare Advantage plans. Plans are rated using a one to five-star scale, with five stars being the highest quality. If a plan is rated less than 2.5 stars, Medicare will not allow new members to enroll.
Compare Blue Medicare HMO Enhanced with these top rated plans available in Greene County:
- Blue Medicare HMO Medical Only
- Blue Medicare HMO Essential
- Gateway Health Medicare Assured Prime
- Gateway Health Medicare Assured Select
- HumanaChoice R1390-001
Blue Medicare HMO Enhanced Availability
Blue Medicare HMO Enhanced is available in Snow Hill, Hookerton, Maury, Walstonburg, and all other areas of Greene County.
This page was last updated on 10/14/2017.
Plan data on Medicare-Plans.net comes from CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.
This page is a brief summary, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly.
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