2018 BCBSHP MediBlue Plus (HMO) H5422-9-0 in GA from Blue Cross Blue Shield of Georgia | HealthPocket

BCBSHP MediBlue Plus (HMO)

Medicare Advantage Plan for Georgia

select spinner
PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlue Cross Blue Shield of Georgia
Plan IDH5422-9-0
CMS Rating1
Plan TypeHMO
Annual Deductible$0.00

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
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$4,900 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
$295 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
$0-295 per visit
Doctor visits
Primary:
$0 copay
Specialist:
$0-40 per visit
Preventive care
$0 copay
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:
$0-200
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
$225-250
Outpatient x-rays:
$100-125
Mental health services
$295 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$0-40
Outpatient individual therapy visit with a psychiatrist:
$0-40
Outpatient group therapy visit:
$0-40
Outpatient individual therapy visit:
$0-40
Skilled Nursing Facility
Tier 1
$0 for days 1 through 20
$137.50 for days 21 through 100
Tier 2
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$40
Physical therapy and speech and language therapy visit:
$40
Ambulance
$295 or 20%
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
$0-50
Routine foot care:
$0 copay
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
$0 or 20% per item
Prosthetics (e.g., braces, artificial limbs):
$0 or 20% per item
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for BCBSHP MediBlue Plus (HMO)

StateGeorgia
CountyGwinnett

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$0 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$12 copay$17 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$95 copay$100 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$15 copayNot offered
Tier 2: Non-Preferred Generic$36 copay$51 copayNot offered
Tier 3: Preferred Brand Name$126 copay$141 copayNot offered
Tier 4: Non-Preferred Brand Name$285 copay$300 copayNot offered
Tier 5: Specialty Tier

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
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Not Rated
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Not Rated
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
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 BCBSHP MediBlue Plus (HMO) for Georgia

/
Fitzgerald-soapes, S
3685 Lawrenceville Hwy
Lawrenceville, GA 30044
Mafoueka Nguena, Victorine
3664 Club Dr Ste 201
Lawrenceville, GA 30044
Dikkala, Venkateswara
2775 Cruse Rd
Lawrenceville, GA 30044
Yusuff, Shelly
1844 Old Norcross Rd Bldg C Suite 200
Lawrenceville, GA 30044
Piland, Kevin
1455 Pleasant Hill Rd
Lawrenceville, GA 30044
Andrews, Andrea
1430 Five Forks Trickum Rd Ste 220
Lawrenceville, GA 30044
Onasanya, Babatunde
605 Beaver Ruin Rd Nw
Lilburn, GA 30047
Hashim, Akber
3100 Five Forks Trickum Rd
Liburn, GA 30047
Lenchner, Keith
100 Old Ballground Hwy
Canton, GA 30047
Wilson, Danelle
976 Killian Hill Rd
Lilburn, GA 30047
Tablan, Ofelia
470 Pleasant Hill Rd Nw
Lilburn, GA 30047
Wang, Minsheng
4705 Lawrenceville Hwy Nw Ste B
Lilburn, GA 30047
Patel, Sandeep
35 Collier Rd Nw
Atlanta, GA 30309
Ireland, Sheryl
966a Killian Hl Rd Sw
Lilburn, GA 30047
Davis-boutte, Windell
4650 Stone Mountain Ga
Lilburn, GA 30047
Hall, Frenesa
1928 Lake Lucerne Dr Sw
Lilburn, GA 30047
Details
S Fitzgerald-soapes, M.D.
Phone Number
(770) 921-7386
Office Locations
3685 Lawrenceville Hwy
Lawrenceville, GA 30044
3685 Lawrenceville Hwy Lawrenceville GA, 30044

Similar Plans

PremiumPlan NameCMS Rating
from $19
SilverScript Choice (PDP)
Details
from $12
EnvisionRxPlus (PDP)
Details
from $17
Aetna Medicare Rx Select (PDP)
Details
from $22
Express Scripts Medicare - Saver (PDP)
Details
from $20
Humana Walmart Rx Plan (PDP)
Details

Related Articles

Related Searches

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

{}