Blue Advantage Complete (PPO)

Medicare Advantage Plan for Alabama

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlue Cross Blue Shield of Alabama
Plan IDH0104-14-0
CMS Rating1
Plan TypePPO
Annual Deductible$150.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium
  • was the best selling plan in Baldwin in 2018

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$7,500 In and Out-of-network $5,000 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$215 for days 1 through 7
$0 for days 8 through 90
$0 for days 91 and beyond
Out-of-Network:
50% per stay
Outpatient hospital coverage
In-Network:
$250 per visit
Out-of-Network:
50% per visit
Doctor visits
Primary:
In-Network:
$10 per visit
Out-of-Network:
50% per visit
Specialist:
In-Network:
$40 per visit
Out-of-Network:
50% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
50%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$10-40 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0 copay
Out-of-Network:
50%
Lab services:
In-Network:
$0 copay
Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):
In-Network:
$50
Out-of-Network:
50%
Outpatient x-rays:
In-Network:
$15
Out-of-Network:
50%
Mental health services
In-Network:
$215 for days 1 through 7
$0 for days 8 through 90
Out-of-Network:
50% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
50%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$35
Out-of-Network:
50%
Outpatient group therapy visit:
In-Network:
$35
Out-of-Network:
50%
Outpatient individual therapy visit:
In-Network:
$35
Out-of-Network:
50%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$150 for days 21 through 54
$0 for days 55 through 100
Out-of-Network:
50% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
50%
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
50%
Ambulance
In-Network:
$200
Out-of-Network:
$200
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$20
Out-of-Network:
50%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
50% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
50% per item
Diabetes supplies:
In-Network:
$0 copay
Out-of-Network:
50% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
50%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
50%

Coverage Area for Blue Advantage Complete (PPO)

StateAlabama
CountyJefferson

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copayNot offered
Tier 2: Non-Preferred Generic$20 copay$20 copayNot offered
Tier 3: Preferred Brand Name$47 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsuranceNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$8 copay$12 copayNot offered
Tier 2: Non-Preferred Generic$40 copay$60 copayNot offered
Tier 3: Preferred Brand Name$94 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name50% coinsurance50% coinsuranceNot offered
Tier 5: Specialty Tier25% coinsurance25% coinsuranceNot offered

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Blue Advantage Complete (PPO) for Alabama

/
CUSTIS, JAMES
9772 PARKWAY E
BIRMINGHAM, AL 35215
HIGGINS, STEPHEN
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
MOORE, KATHERINE
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
VONDER POOL, BEVERLY
2152 OLD SPRINGVILLE RD
BIRMINGHAM, AL 35215
POWELL, MICHAEL
9772 PARKWAY E
BIRMINGHAM, AL 35215
ROBBINS, COURTNEY
1401 EDWARDS LAKE RD
BIRMINGHAM, AL 35235
BAKER, RYAN
5066 PINNACLE SQ
BIRMINGHAM, AL 35235
BOYD, SHAMEZA
52 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
LEFF K ROBBINS JR MD HOSPITALIST SERVICES PC
50 MEDICAL PARK EAST DRIVE
BIRMINGHAM, AL 35235
LOWERY, DOUGLAS
1809 GADSDEN HWY
BIRMINGHAM, AL 35235
ANESTHESIA GROUP EAST PC
52 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
SLAPPEY, CARTER
48 MEDICAL PARK EAST DRIVE
BIRMINGHAM, AL 35235
STINSON, ALVIA
48 MEDICAL PARK E DR
BIRMINGHAM, AL 35235
LANGLOW, JOHN
50 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
HORNE, LAURA
100 PILOT MEDICAL DR.
BIRMINGHAM, AL 35235
PAYNE, R
48 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
MALOOF, JOHN
48 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
MENZEL, CHARLOTTE
50 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
LUCAS, JOSEPH
3504 VANN RD
BIRMINGHAM, AL 35235
SMITH, ELIZABETH
52 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
SCHMITT, KIM
52 MEDICAL PARK EAST DR
BIRMINGHAM, AL 35235
TUCKER, KENT
100 PILOT MEDICAL DRIVE
BIRMINGHAM, AL 35235
WILLIAMS, SHARON
48 MEDICAL PARK DR E
BIRMINGHAM, AL 35235
LAKHANPAL, SHAILENDRA
100 PILOT MEDICAL DRIVE
BIRMINGHAM, AL 35235
Details
JAMES CUSTIS, MD
Phone Number
(205) 833-6888
Office Locations
9772 PARKWAY E
BIRMINGHAM, AL 35215
9772 PARKWAY E BIRMINGHAM AL, 35215

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