Blue Advantage (HMO)

Medicare Advantage Plan for Louisiana

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlue Cross Blue Shield of Louisiana
Plan IDH6453-3-0
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
  • was the 4th best selling plan in St. Tammany Parish 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-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
$195 for days 1 through 10
$0 for days 11 through 90
$195 for days 91 through 100
$0 for days 101 and beyond
Outpatient hospital coverage
$200 or 20% per visit
Doctor visits
Primary:
$0 copay
Specialist:
$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:
$11
Lab services:
$11
Diagnostic radiology services (e.g., MRI):
$200
Outpatient x-rays:
$0-35
Mental health services
$195 for days 1 through 8
$0 for days 9 through 90
Outpatient group therapy visit with a psychiatrist:
$40
Outpatient individual therapy visit with a psychiatrist:
$40
Outpatient group therapy visit:
$40
Outpatient individual therapy visit:
$40
Skilled Nursing Facility
$0 for days 1 through 20
$165 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$20
Physical therapy and speech and language therapy visit:
$20
Ambulance
$245
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$40
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
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 Blue Advantage (HMO)

StateLouisiana
CountyEast Baton Rouge Parish

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 GenericNot offereds$3 copayNot offered
Tier 2: Non-Preferred GenericNot offered$12 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$100 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$9 copayNot offered
Tier 2: Non-Preferred GenericNot offered$36 copayNot offered
Tier 3: Preferred Brand NameNot offered$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$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
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Not Rated
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
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
Not Rated
Plan all-cause readmissions
Not Rated

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
Not Rated
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
Not Rated

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 (HMO) for Louisiana

/
LAURENT, JOHN
14635 S HARRELLS FERRY RD
BATON ROUGE, LA 70816
HOLMES, KEITH
2345 ONEAL LN
BATON ROUGE, LA 70816
JOHNSTON, FRANCIS
1940 ONEAL LN
BATON ROUGE, LA 70816
GOMEZ, NIKKI
11140 N HARRELLS FERRY RD
BATON ROUGE, LA 70816
PARDY, JANIS
11140 N HARRELLS FERRY RD
BATON ROUGE, LA 70816
SILVIO, KAYLA
11140 N. HARRELLS FERRY RD.
BATON ROUGE, LA 70816
CHAPMAN, KAYLA
11140 N. HARRELLS FERRY ROAD
BATON ROUGE, LA 70816
STAFFORD, ANGELA
15420 S HARRELLS FERRY RD
BATON ROUGE, LA 70816
SCOFIELD, EMILY
11140 N HARRELLS FERRY RD
BATON ROUGE, LA 70816
HARRIS, ANGELA
16777 MEDICAL CENTER DRIVE
BATON ROUGE, LA 70816
MORVANT, KRISTIN
16777 MEDICAL CENTER
BATON ROUGE, LA 70816
IDOWU, BEN
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
LEA, RANDALL
17 ALICE PECK DAY DR
LEBANON, NH 03766
WAHID, SAIYID
1962 ONEAL LN
BATON ROUGE, LA 70816
NNADI, JOHN
17000 MEDICAL CENTER DR
BATON ROUGE, LA 70816
BAUCOM, CATHERINE
17050 MEDICAL CENTER DR
BATON ROUGE, LA 70816
KOZAR, BRIAN
16777 MEDICAL CENTER DR
BATON ROUGE, LA 70816
ELLIOTT, ROBERT
17050 MEDICAL CENTER DR STE 400
BATON ROUGE, LA 70816
MCCAULEY, LINDA
16777 MEDICAL CENTER DR
BATON ROUGE, LA 70816
MCKINNEY, ROBERT
2345 ONEAL LN
BATON ROUGE, LA 70816
VUONG, HIEU
3851 S SHERWOOD FOREST BLVD
BATON ROUGE, LA 70816
GESN, LOIS
2345 ONEAL LN
BATON ROUGE, LA 70816
LEBLANC, CHERI
15165 S HARRELLS FERRY RD
BATON ROUGE, LA 70816
FLINT, CAROLINE
2345 ONEAL LN
BATON ROUGE, LA 70816
GIROD, TYRONE
5617 GALERIA DR
BATON ROUGE, LA 70816
Details
JOHN LAURENT, PT, MPT, OCS, CSCS
Phone Number
(225) 756-4844
Office Locations
14635 S HARRELLS FERRY RD
BATON ROUGE, LA 70816
14635 S HARRELLS FERRY RD BATON ROUGE LA, 70816

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