2019 Blue Medicare Advantage (Medicare-Medicaid Plan) H0927-1-0 in IL from Blue Cross Blue Shield of Illinois | HealthPocket

Blue Medicare Advantage (Medicare-Medicaid Plan)

$0/mo

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Zip Code60629
Applicant9/16/1984 Male
Coverage Start9/17/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlue Cross Blue Shield of Illinois
Plan IDH0927-1-0
Plan Year2019
CMS RatingNot Rated
Plan TypeMedicare-Medicaid Plan
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

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)Not Applicable
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$0 copay
Outpatient hospital coverage$0 copay
Doctor visitsPrimary:$0 copay
Specialist:$0 copay
Preventive care$0 copay
Emergency care/Urgent careEmergency:$0 copay
Urgent care:$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$0 copay
Outpatient x-rays:$0 copay
Mental health servicesInpatient hospital - psychiatric:$0 copay
Outpatient group therapy visit with a psychiatrist:$0 copay
Outpatient individual therapy visit with a psychiatrist:$0 copay
Outpatient group therapy visit:$0 copay
Outpatient individual therapy visit:$0 copay
Skilled Nursing Facility$0 copay
Rehabilitation servicesOccupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ground ambulance$0 copay
Transportation$0 copay
Foot care (podiatry services)Foot exams and treatment:$0 copay
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):$0 copay
Prosthetics (e.g., braces, artificial limbs):$0 copay
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:$0 copay
Other Part B drugs:$0 copay

Benefits Services

Hearing
Hearing exam$0 copay
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$0 copay. There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatment$0 copay. There may be limits on how much the plan will provide.
Dental x-ray(s)Not covered
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic services$0 copay. There may be limits on how much the plan will provide.
Restorative services$0 copay. There may be limits on how much the plan will provide.
Endodontics$0 copay. There may be limits on how much the plan will provide.
Periodontics$0 copay. There may be limits on how much the plan will provide.
Extractions$0 copay. There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay. There may be limits on how much the plan will provide.
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
Other$0 copay. There may be limits on how much the plan will provide.
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass framesNot covered
Eyeglass lenses$0 copay. There may be limits on how much the plan will provide.
Upgrades$0 copay. There may be limits on how much the plan will provide.

Coverage Area for Blue Medicare Advantage (Medicare-Medicaid )

StateIllinois
CountyCook

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 GenericNot offereds0% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered0% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered0% coinsuranceNot offered
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered0% coinsuranceNot offered
Tier 2: Non-Preferred GenericNot offered0% coinsuranceNot offered
Tier 3: Preferred Brand NameNot offered0% coinsuranceNot offered
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

Physicians that accept Blue Medicare Advantage (Medicare-Medicaid ) for Illinois

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Andree, De Bustros
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Guadalupe, Bustamante
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Theodore, Christou
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Physical Therapy Providers Inc.
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Horizon Physical Therapy Pc
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Lisa, Daniel
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Erin, Jamen
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Karen, Raden
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Jennifer, Perez
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Keith, Boyd
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Holy Cross Hospital Anesthesia
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Susan P Albovias Md
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Chicago Foot And Ankle Pc
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Parakrama, De Silva
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Smain, Sadok
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Leticia, Rico-herrera
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Charles, Allen
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Maria, Reyes
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Anthony, Bozzano
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Luis, Angarita
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Eleazar, Calero
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Jolan, Fejes
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Kiran, Gandhi
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Marko, Lekovic
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Andree De Bustros, M.D.
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  • Phone Number
    (312) 567-7500
  • Office Locations
    5525 S Pulaski Rd
    Chicago, IL 60629
5525 S Pulaski Rd Chicago IL, 60629

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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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

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. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)