Medicare Advantage Plan Benefit Details in Plain Text |
The following Medicare Advantage plan benefits apply to the Platinum Blue Complete Plan (Cost) (H2461 - 007) in Olmsted, Minnesota .
This plan is administered by . To switch to a different Medicare Advantage plan or to change your location, click here. |
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Plan Premium |
The Platinum Blue Complete Plan (Cost) has a monthly premium of $145.00. That is $1,740.00 for 12 months. There are a few factors that can increase or decrease this premium.
If you qualify for full or partial extra help, your premium will be lower. If you have a premium penalty, your premium will be higher.
Please remember that the $145.00 montly premium is in addition to your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).
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This Medicare Advantage Plan without Prescription Drug Coverage is a Cost * plan.
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Plan Membership and Plan Ratings |
The Platinum Blue Complete Plan (Cost) (H2461 - 007) currently has 108,866 members. There are 3,428 members enrolled in this plan in Olmsted, Minnesota, and 60,120 members in Minnesota.
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The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 5 stars. Therefore, this plan qualifies for the 5-star rating Special Enrollment period ( Read more). The detail CMS plan carrier ratings are as follows: - Customer Service Rating of 5 out of 5 stars
- Member Experience Rating not available
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Please be aware that this plan does NOT include Prescription Drug Coverage! |
The Platinum Blue Complete Plan (Cost) offers many Health Coverage Benefits. The following section will describe these benefits in detail. |
** Benefit Highlights ** |
Health plan deductible |
• $0 |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) |
• $4,000 In-network |
Optional supplemental benefits |
• No |
Inpatient hospital coverage |
• $100 per stay |
Outpatient hospital coverage |
• $0 copay |
Preventive care |
• $0 copay |
Other health plan deductibles? |
• In-Network: No |
Doctor visits |
• Primary: $0 copay |
• Specialist: $0 copay |
Emergency care/Urgent care |
• Emergency: $0 copay |
• Urgent care: $0 copay |
Diagnostic procedures/lab services/imaging |
• Diagnostic tests and procedures: $0 copay |
• Lab services: $0 copay |
• Diagnostic radiology services (e.g., MRI): $0 copay |
• Outpatient x-rays: $0 copay |
Mental health services |
• $100 per stay |
Skilled Nursing Facility |
• $0 copay |
Ambulance |
• $0 copay |
Transportation |
• Not covered |
Wellness programs (e.g., fitness, nursing hotline) |
• Covered |
Mental health services |
• Outpatient group therapy visit with a psychiatrist: $0 copay |
• Outpatient individual therapy visit with a psychiatrist: $0 copay |
• Outpatient group therapy visit: $0 copay |
• Outpatient individual therapy visit: $0 copay |
Rehabilitation services |
• Occupational therapy visit: $0 copay |
• Physical therapy and speech and language therapy visit: $0 copay |
Foot care (podiatry services) |
• Foot exams and treatment: $0 copay |
• Routine foot care: Not covered |
Medical equipment/supplies |
• Durable medical equipment (e.g., wheelchairs, oxygen): $0 copay |
• Prosthetics (e.g., braces, artificial limbs): $0 copay |
• Diabetes supplies: $0 copay |
Medicare Part B drugs |
• Chemotherapy: 20% |
• Other Part B drugs: 0-20% |
** Benefits Services ** |
Hearing |
• Hearing exam: $0 copay |
• Fitting/evaluation: $0 copay |
• Hearing aids: $0 copay |
Preventive dental |
• Oral exam: Not covered |
• Cleaning: Not covered |
• Fluoride treatment: Not covered |
• Dental x-ray(s): Not covered |
Comprehensive dental |
• Non-routine services: Not covered |
• Diagnostic services: Not covered |
• Restorative services: Not covered |
• Endodontics: Not covered |
• Periodontics: Not covered |
• Extractions: Not covered |
• Prosthodontics, other oral/maxillofacial surgery, other services: Not covered |
Vision |
• Routine eye exam: $0 copay |
• Other: $0 copay |
• Contact lenses: $0 copay |
• Eyeglasses (frames and lenses): $0 copay |
• Eyeglass frames: Not covered |
• Eyeglass lenses: Not covered |
• Upgrades: Not covered | |