Blue Medicare Access Value and Standard Review

The Blue Medicare Access Value and Blue Medicare Access Standard plans are two Medicare Advantage Regional PPOs offered by Anthem Blue Cross and Blue Shield.  They are available in Kentucky, Indiana, and Ohio only, and you must reside in one of the covered counties in these states in order to enroll.  The regional PPO is always nice because it offers flexibility in using the coverage.  Since it is offered by Blue Cross you would expect it to have some good coverage.  Let’s take a look at what the plans offer below:

Blue Medicare Access Value (Regional PPO)

  • Premium – $0/monthly
  • Maximum Out of Pocket – $4,200 in Kentucky + Indiana; $4,800 in Ohio
  • No referrals required, and you can go to any doctor – You will pay more OUT of Network
  • Hospital – $200/day, Days 1-7 in Kentucky + Indiana; $270/day, Days 1-5 in Ohio
  • Doctor’s Visits – $25 = Primary; $40 = Specialists in Kentucky + Indiana; $20 + $35 in Ohio
  • Outpatient Surgery – $0 – $185 in Kentucky + Indiana; $0 – $250 in Ohio
  • Labs – $0 for all states
  • Diagnostic Procedures – $0 – $160 in Kentucky + Indiana; $0 – $155 in Ohio
  • X-rays – $85 in Kentucky + Indiana; $95 in Ohio
  • Part D Deductible – $60 for all states
  • Part D Drugs – Tier 1 = $7; Tier 2 = $43; Tier 3 = $85; Tier 4 + 5 = 33%; Tier 6 = $7 for all states
  • Routine dental, vision, and hearing not included, but available for purchase

Blue Medicare Access Standard (Regional PPO)

  • Only in Kentucky and Indiana
  • Premium – $43/monthly
  • Maximum Out of Pocket – $3,400
  • No referrals required, and you can go to any doctor – You will pay more OUT of Network
  • Hospital – $165/day, Days 1-9
  • Doctor’s Visits – $20 = Primary; $30 = Specialists
  • Outpatient Surgery – $0 – $200
  • Labs – $0 for all states
  • Diagnostic Procedures – $0 – $140
  • X-rays – $85
  • Part D Deductible – $60
  • Part D Drugs – Tier 1 = $7; Tier 2 = $43; Tier 3 = $85; Tier 4 + 5 = 33%; Tier 6 = $7
  • Routine dental, vision, and hearing are included

There does not appear to be a huge difference in coverage between the Value and Standard plans other than the preventative dental and vision.  I would probably recommend the Value plan!  These amounts are for in-network copays.  Out of network can cost you significantly more on PPO plans.  Make sure you look up your providers to see if they are in the plan’s network.

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