Blue adVantage Platinum (HMO-POS)

Available to residents of Washington County, LA for 2027. Contract H6453, plan 018, segment 2.

2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.

Plan details

Monthly premium (Part C + D)	$249.00
— medical (Part C) part	$220.90
— drug (Part D) part	$28.10?
Monthly premium with full Extra Help (LIS)	$232.00?drug (Part D) part $11.10; Extra Help does not cover the medical (Part C) premium
Part B premium reduction (giveback)	None
Health plan deductible (in-network)	None
In-network out-of-pocket maximum	$3,500.00?
Drug deductible	$450.00Tier 1 and 2 exempt
Drug out-of-pocket threshold	$2,400.00
Plan type	HMO-POS?
Contract / plan	H6453-018-2
Offered by	Blue Cross and Blue Shield of Louisiana
Parent organization	Louisiana Health Service & Indemnity Company
Formulary tiers	5
Formulary exception tier	4?
Pharmacy search	www.lablue.com/blueadvantage
Member services	(800)363-9152TTY 711

CMS star ratings

Overall: 3.5 out of 5 stars for Overall
Health plan (Part C): 3.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3.5 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H6453 shares this rating.

Plan health benefits

Service	In-network
Doctor visits
Primary care doctor	$0 copay
Specialist	$25 copay(authorization required)
Other health care professional	$0–$25 copay; 20% coinsurance(authorization required)
Additional telehealth services	$0–$35 copay(authorization required)
Preventive care
Medicare-covered preventive services	$0 copay
Annual physical exam	$0 copay
Kidney disease education	$0 copay
Glaucoma screening	$0 copay
Diabetes self-management training	$0 copay
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$0–$30 copay(authorization required)
Lab services	$0–$35 copay(authorization required)
Diagnostic radiology (e.g. MRI, CT)	$0–$280 copay(authorization required)
Therapeutic radiology	20% coinsurance(authorization required)
Outpatient x-rays	0%–20% coinsurance(authorization required)
Emergency and urgent care
Emergency room	$150 copay
Urgent care	$40 copay
Worldwide emergency coverage	$150 copay
Worldwide urgent care	Not covered
Worldwide emergency transportation	Not covered
Hospital care
Inpatient hospital stay	$205 per day for days 1–7; $0 per day for days 8–90(authorization required)
Outpatient hospital services	$0–$150 copay(authorization required)
Outpatient observation	$205 copay(authorization required)
Ambulatory surgical center	$0–$150 copay(authorization required)
Outpatient blood services	$0 copay
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $200 per day for days 21–100(authorization required)
Home health care	$0 copay(authorization required)
Kidney dialysis	20% coinsurance
Rehabilitation
Occupational therapy	$35 copay(authorization required)
Physical therapy and speech-language therapy	$35 copay(authorization required)
Cardiac rehabilitation	$20 copay(authorization required)
Pulmonary rehabilitation	$15 copay(authorization required)
Mental health and substance use
Inpatient psychiatric hospital stay	$225 per day for days 1–7; $0 per day for days 8–90(authorization required)
Outpatient mental health, individual session	$20 copay(authorization required)
Outpatient mental health, group session	$20 copay(authorization required)
Psychiatrist, individual session	$20 copay(authorization required)
Psychiatrist, group session	$20 copay(authorization required)
Partial hospitalization	$60 copay(authorization required)
Intensive outpatient program	$60 copay(authorization required)
Outpatient substance use, individual session	$20 copay(authorization required)
Outpatient substance use, group session	$20 copay(authorization required)
Opioid treatment program	$40 copay(authorization required)
Ambulance and transportation
Ground ambulance	$250 copay
Air ambulance	$260 copay
Transportation to plan-approved locations	Not covered
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)
Medical supplies	20% coinsurance(authorization required)
Diabetes supplies	$0 copay(authorization required)
Diabetic therapeutic shoes or inserts	$0 copay(authorization required)
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$20 copay
Routine chiropractic care	Not covered
Acupuncture	Not covered
Foot exams and treatment (Medicare-covered)	$25 copay(authorization required)
Routine foot care	Not covered
Dental?
Medicare-covered dental services	$0 copay
Preventive dental plan limit	$2,700 plan limit every year
Oral exams	$0 copay(limits apply)
Cleanings	$0 copay(limits apply)
Fluoride treatment	$0 copay(limits apply)
Dental x-rays	$0 copay(limits apply)
Other diagnostic dental services	$0 copay(limits apply)
Other preventive dental services	Not covered
Restorative services (fillings, crowns)	$0 copay
Endodontics (root canals)	$0 copay
Periodontics (gum disease)	$0 copay
Dentures and other removable prosthodontics	$0 copay
Maxillofacial prosthetics	Not covered
Implants	Not covered
Bridges and other fixed prosthodontics	$0 copay
Oral and maxillofacial surgery	$0 copay
Orthodontics	Not covered
Adjunctive general services	$0 copay
Vision?
Eye exam (Medicare-covered)	$25 copay(authorization required)
Routine eye exam	$0 copay(authorization required, limits apply)
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)
Eyewear plan limit	$200 plan limit every year
Contact lenses	$0 copay(limits apply)
Eyeglasses (frames and lenses)	$0 copay(limits apply)
Eyeglass lenses	$0 copay(limits apply)
Eyeglass frames	$0 copay(limits apply)
Eyewear upgrades	$0 copay(limits apply)
Hearing?
Hearing exam (Medicare-covered)	$0 copay
Routine hearing exam	$0 copay(limits apply)
Hearing aid fitting and evaluation	$0 copay
Hearing aid plan limit	$800 plan limit every three years
Hearing aids (all types)	$0 copay(limits apply)
Hearing aids, inner ear	Not covered
Hearing aids, outer ear	Not covered
Hearing aids, over the ear	Not covered
Medicare Part B drugs
Part B insulin	$35 copay(authorization required, step therapy may apply)
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)
Meals after a hospital stay or for a chronic condition	Not covered
Fitness benefit	$0 copay
Health education	Not covered
Nutritional / dietary benefit	Not covered
Extra smoking and tobacco cessation counseling	Not covered
Enhanced disease management	Not covered
Telemonitoring	Not covered
Remote access technologies (web/phone, nurse line)	Not covered
Home and bathroom safety devices	Not covered
Counseling services	Not covered
In-home safety assessment	Not covered
Personal emergency response system (PERS)	Not covered
Medical nutrition therapy	Not covered
Post-discharge in-home medication reconciliation	Not covered
Re-admission prevention	Not covered
Wigs for hair loss from chemotherapy	Not covered
Weight management programs	Not covered
Alternative therapies	Not covered
Therapeutic massage	Not covered
Adult day health services	Not covered
Home-based palliative care	$0 copay
In-home support services	Not covered
Support for caregivers	Not covered

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1 · Preferred Generic	$0.00
Tier 2 · Generic	$12.00
Tier 3 · Preferred Brand	$45.00
Tier 4 · Non-Preferred Drug	50%
Tier 5 · Specialty Tier	28%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$12.00	$12.00	$12.00	$36.00	$36.00	$36.00
Tier 3: Preferred Brand	$45.00	$45.00	$45.00	$135.00	$135.00	$135.00
Tier 4: Non-Preferred Drug	50%	50%	50%	50%	50%	50%
Tier 5: Specialty Tier	28%	28%	28%	n/a	n/a	n/a

These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.

Star rating measures

Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H6453 shares it.

Benefits in plain text

Blue adVantage Platinum (HMO-POS) (H6453-018-2) is a 2027 HMO-POS Medicare Advantage plan offered by Blue Cross and Blue Shield of Louisiana, available to residents of Washington County, LA.

The monthly premium is $249.00.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $232.00.

There is no in-network deductible for health services.

Its in-network out-of-pocket maximum is $3,500.00.

The drug deductible is $450.00. Tier 1 and 2 exempt.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $12.00; tier 3 (Preferred Brand): $45.00; tier 4 (Non-Preferred Drug): 50%; tier 5 (Specialty Tier): 28%.

CMS gives the plan's contract (H6453) an overall rating of 3.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.