AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)

Medicare Advantage Plan for Arkansas

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderArkansas Blue Cross Blue Shield
Plan IDH4213-17-1
CMS Rating1
Plan TypePFFS
Annual Deductible$200.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • was the 2nd best selling plan in Baxter 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)
$6,700 In and Out-of-network
Other health plan deductibles?
No
Health Plan Deductible
$500 Out-of-network
Monthly Drug Plan Premium
$23.50
Monthly Health Plan Premium
$21.00

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$350 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
40% per stay
$350 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
In-Network:
$315 per visit. Out-of-Network:
$315 or 40% per visit
Doctor visits
Primary:In-Network:
$20 per visit. Out-of-Network:
$20 or 40% per visit
Specialist:In-Network:
$50 per visit. Out-of-Network:
$50 or 40% per visit
Preventive care
In-Network:
$0 copay. Out-of-Network:
0-40%
Emergency care/Urgent care
Emergency:$80 per visit (always covered)
Urgent care:$35 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:In-Network:
20%Out-of-Network:
20-40%
Lab services:In-Network:
$0 copay. Out-of-Network:
0-40%
Diagnostic radiology services (e.g., MRI):In-Network:
$315Out-of-Network:
$315 or 40%
Outpatient x-rays:In-Network:
20%Out-of-Network:
20-40%
Mental health services
In-Network:
$295 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
40% per stay
$295 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
$40 or 40%
Outpatient individual therapy visit with a psychiatrist:In-Network:
$40Out-of-Network:
$40 or 40%
Outpatient group therapy visit:In-Network:
$40Out-of-Network:
$40 or 40%
Outpatient individual therapy visit:In-Network:
$40Out-of-Network:
$40 or 40%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
40% per stay
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:In-Network:
$40Out-of-Network:
$40 or 40%
Physical therapy and speech and language therapy visit:In-Network:
$40Out-of-Network:
$40 or 40%
Ambulance
In-Network:
$350Out-of-Network:
$350
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:In-Network:
$50-315Out-of-Network:
$50-315 or 40%
Routine foot care:Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network:
20% per item. Out-of-Network:
20-40% per item
Prosthetics (e.g., braces, artificial limbs):In-Network:
20% per item. Out-of-Network:
20-40% per item
Diabetes supplies:In-Network:
20% per item. Out-of-Network:
20-40% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:In-Network:
20%Out-of-Network:
20-40%
Other Part B drugs:In-Network:
20%Out-of-Network:
20-40%

Coverage Area for AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)

StateArkansas
CountyPulaski

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$3 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$13 copay$20 copayNot offered
Tier 3: Preferred Brand Name$40 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$93 copay$100 copayNot offered
Tier 5: Specialty Tier29% coinsurance29% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$7.5 copay$25 copayNot offered
Tier 2: Non-Preferred Generic$32.5 copay$50 copayNot offered
Tier 3: Preferred Brand Name$100 copay$117.5 copayNot offered
Tier 4: Non-Preferred Brand Name$232.5 copay$250 copayNot offered
Tier 5: Specialty Tier29% coinsurance29% 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
Not Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Not Rated
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
Not Rated
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 AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS) for Arkansas

/
OVERTON, JENNIFER
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
MORTENSEN, ALEISHA
6917 GEYER SPRINGS ROAD
LITTLE ROCK, AR 72209
JOHN, CHRISTOPHER
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
CARUTHERS, CAROL
6924 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
HOP SKIP AND JUMP INC
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
CARNEY, JOHN
11321 I-30
LITTLE ROCK, AR 72209
CROWELL, BERNARD
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
BADHWAR, ANIL
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
SNYDER, STEPHEN
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
ABDELAL, AHMED
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
BUDHRAJA, MEENAKSHI
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
SCALLION, SARA
8023 INTERSTATE 30
LITTLE ROCK, AR 72209
ADAMETZ, JOHN
10101 MABELVALE PLAZA DR STE 3
LITTLE ROCK, AR 72209
BUDHRAJA, MADHU
11321 INTERSTATE 30
LITTLE ROCK, AR 72209
WEATHERSBY, KEM
8109 INTERSTATE 30
LITTLE ROCK, AR 72209
JENNINGS, LAURA
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
WOLVERTON, JOHN
6924 GEYER SPRINGS
LITTLE ROCK, AR 72209
JIMMERSON FAMILY HEALTH CARE P.A.
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
KUPERMAN, IRVING
5300 MABELVALE PIKE
LITTLE ROCK, AR 72209
BINZ, KEVIN
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
DECKER, TRICIA
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
KHAN, MAHMOOD
11401 INTERSTATE 30
LITTLE ROCK, AR 72209
Details
JENNIFER OVERTON, MS CCCSLP
Phone Number
(501) 570-4004
Office Locations
6917 GEYER SPRINGS RD
LITTLE ROCK, AR 72209
6917 GEYER SPRINGS RD LITTLE ROCK AR, 72209

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