2019 Secure Blue no Rx (PPO) H1302-4-0 in ID from Blue Cross of Idaho | HealthPocket

Secure Blue no Rx (PPO)

$29/mo

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Zip Code83709
Applicant12/14/1983 Male
Coverage Start12/15/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C)
Insurance ProviderBlue Cross of Idaho
Plan IDH1302-4-0
Plan Year2019
CMS RatingNot Rated
Plan TypePPO
Annual Deductible$0.00

What To Know About This Plan
  • This is a health coverage only plan with no drug coverage

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$29.00
Monthly Drug Plan PremiumNot Applicable
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$5,000 In and Out-of-network
$3,400 In-network
Optional Supplemental BenefitsYes

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$175 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:$200 per day for days 1 through 10
$0 per day for days 11 and beyond
Outpatient hospital coverageIn-Network:$175 per visit
Out-of-Network:20% per visit
Doctor visitsPrimary:
In-Network:$15 per visit
Out-of-Network:$30 per visit
Specialist:
In-Network:$25 per visit
Out-of-Network:$30 per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$25 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:10%
Out-of-Network:25%
Lab services:
In-Network:10%
Out-of-Network:25%
Diagnostic radiology services (e.g., MRI):
In-Network:10%
Out-of-Network:25%
Outpatient x-rays:
In-Network:10%
Out-of-Network:25%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$175 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:$200 per day for days 1 through 10
$0 per day for days 11 through 90
Outpatient group therapy visit with a psychiatrist:
In-Network:$25
Out-of-Network:25%
Outpatient individual therapy visit with a psychiatrist:
In-Network:$25
Out-of-Network:25%
Outpatient group therapy visit:
In-Network:$25
Out-of-Network:25%
Outpatient individual therapy visit:
In-Network:$25
Out-of-Network:25%
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$150 per day for days 21 through 100
Out-of-Network:$100 per day for days 1 through 12
$150 per day for days 13 through 100
Rehabilitation servicesOccupational therapy visit:
In-Network:$25
Out-of-Network:$30
Physical therapy and speech and language therapy visit:
In-Network:$25
Out-of-Network:$30
Ground ambulanceIn-Network:$175
Out-of-Network:$175
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$25
Out-of-Network:$30
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:10% per item
Out-of-Network:20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:10% per item
Out-of-Network:20% per item
Diabetes supplies:
In-Network:$0 copay
Out-of-Network:20% per item
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
In-Network:20%
Out-of-Network:30%
Other Part B drugs:
In-Network:20%
Out-of-Network:30%

Benefits Services

Hearing
Hearing examIn-Network: $45
Out-of-Network: $45
Fitting/evaluationNot covered
Hearing aidsIn-Network: $699-999
Out-of-Network: $699-999
There may be limits on how much the plan will provide.
Preventive Dental
Office visitIn-Network: $10.00
Out-of-Network: 50%
Oral examCovered under office visit. There may be limits on how much the plan will provide.
CleaningCovered under office visit. There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)Covered under office visit. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative servicesNot covered
EndodonticsNot covered
PeriodonticsNot covered
ExtractionsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-Network: $20
Out-of-Network: $20
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesIn-Network: $0-35
Out-of-Network: $35
There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)In-Network: $35
Out-of-Network: $35
There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lensesNot covered
UpgradesIn-Network: $0 copay
Out-of-Network: $35
There may be limits on how much the plan will provide.

Coverage Area for Secure Blue no Rx (PPO)

StateIdaho
CountyAda

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccineNot Rated
Improving or maintaining physical healthNot Rated
Improving or maintaining mental healthNot Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot Rated
Osteoporosis management in women who had a fractureNot Rated
Diabetes care – eye examNot Rated
Diabetes care – kidney disease monitoringNot Rated
Diabetes care – blood sugar controlledNot Rated
Controlling blood pressure
Rheumatoid arthritis managementNot Rated
Reducing the risk of falling
Plan all-cause readmissionsNot Rated

Member Experience with Health Plan

Getting needed care
Getting appointments and care quicklyNot Rated
Customer serviceNot Rated
Overall rating of health care qualityNot Rated
Overall rating of planNot Rated
Care CoordinationNot Rated

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health planNot Rated
Members choosing to leave the health planNot Rated
Beneficiary access and performance problemsNot Rated
Health plan quality improvementNot Rated

Health Plan Customer Service

Plan makes timely decision about appealsNot Rated
Reviewing appeals decisionsNot Rated
Call center – foreign language interpreter and TTY/TDD availability - MedicalNot Rated

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - DrugsNot Rated
Appeals auto-forward
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug planNot Rated
Members choosing to leave the drug planNot Rated
Beneficiary access and performance problemsNot Rated
Drug plan quality improvementNot Rated

Member Experience with Drug Plan

Rating of drug planNot Rated
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price AccuracyNot Rated
High risk medicationNot Rated
Part D medication adherence for diabetesNot Rated
Part D medication adherence for hypertensionNot Rated
Part D medication adherence for cholesterolNot Rated
Medication Therapy Management program completion rate Not Rated

Physicians that accept Secure Blue no Rx (PPO) for Idaho

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Mohr, John
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Major, Meikel
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Barney, Alexander
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Markosian, Anna
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Kennedy, Anthony
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Games, Jennifer
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Heckel, Mary
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Treasure Valley Speech And Language, Llc
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Bartlett, Christy
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Sawyer, Brian
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Baker, Carmen
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Mabbutt, Debra
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Mock, Dale
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Sterling, Hugh
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Ryan, Michael
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Edwards, Jeffrey
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Johnson, Shae
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Reyes, Adam
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Murray, Kathryn
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Manning, Thomas
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John Mohr, M.D.
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  • Phone Number
    (208) 362-1015
  • Office Locations
    3301 Terra Dr
    Boise, ID 83709
3301 Terra Dr Boise ID, 83709

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Medicare Plans Found

 

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.