Blue Cross Medicare Advantage Classic (PPO)

Medicare Advantage Plan for Montana

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlueCross BlueShield of Montana
Plan IDH0107-3-0
CMS Rating1
Plan TypePPO
Annual Deductible$405.00

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 a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)
  • was the best selling plan in Cascade 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)
$10,000 In and Out-of-network $6,700 In-network $10,000 Out-of-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$32.70
Monthly Health Plan Premium
$28.30

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$360 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
50% per stay
Outpatient hospital coverage
In-Network:
$0-295 per visit
Out-of-Network:
50% per visit
Doctor visits
Primary:
In-Network:
$15 per visit
Out-of-Network:
50% per visit
Specialist:
In-Network:
$45 per visit
Out-of-Network:
50% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
50%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$65 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$0-50
Out-of-Network:
50%
Lab services:
In-Network:
$5
Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):
In-Network:
$350
Out-of-Network:
50%
Outpatient x-rays:
In-Network:
20%
Out-of-Network:
50%
Mental health services
In-Network:
$324 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
50% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
50%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$30
Out-of-Network:
50%
Outpatient group therapy visit:
In-Network:
$30
Out-of-Network:
50%
Outpatient individual therapy visit:
In-Network:
$30
Out-of-Network:
50%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
50% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
50%
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
50%
Ambulance
In-Network:
$275
Out-of-Network:
$275
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$45
Out-of-Network:
50%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
30% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
50% per item
Diabetes supplies:
In-Network:
0-20% per item
Out-of-Network:
50% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
50%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
50%

Coverage Area for Blue Cross Medicare Advantage Classic (PPO)

StateMontana
CountyYellowstone

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$14 copay$19 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 Tier25% coinsurance25% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$15 copay$0 copay
Tier 2: Non-Preferred Generic$42 copay$57 copay$42 copay
Tier 3: Preferred Brand Name$126 copay$141 copay$126 copay
Tier 4: Non-Preferred Brand Name$285 copay$300 copay$285 copay
Tier 5: Specialty Tier25% coinsurance25% coinsurance25% coinsurance

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
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

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
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 Blue Cross Medicare Advantage Classic (PPO) for Montana

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SCHUPPE, ERICA
50 27TH ST W STE A
BILLINGS, MT 59102
HOHENBERGER, PAULINE
50 27TH ST W STE A
BILLINGS, MT 59102
SELL, TRACI
50 27TH ST W STE A
BILLINGS, MT 59102
HENNING, BETH
50 27TH ST W STE A
BILLINGS, MT 59102
SEIBOLD, CARISSA
3940 RIMROCK RD
BILLINGS, MT 59102
BALISON, JEFFREY
2345 KING AVE W
BILLINGS, MT 59102
DANAHER, JULIE
1884 BROADWATER
BILLINGS, MT 59102
DUEY, JENNELL
2675 CENTRAL AVE
BILLINGS, MT 59102
BURROWS, SHELLYE
2345 KING AVE W
BILLINGS, MT 59102
ZIMMER, VALARIE
2724 BETH DR
BILLINGS, MT 59102
SHECKLETON, GEORGE
1810 MULBERRY DR
BILLINGS, MT 59102
RICHARDSON, KRISTEN
2370 AVENUE C
BILLINGS, MT 59102
MALLOY, LINDA
2802 13TH ST W
BILLINGS, MT 59102
ROBERTS, KRISTINE
2675 CENTRAL AVE
BILLINGS, MT 59102
RICE, NANCY
2048 OVERLAND AVE STE 101
BILLINGS, MT 59102
ANDRE, VICKI
2048 OVERLAND AVE
BILLINGS, MT 59102
GUSHWA, STEPHANIE
3940 RIMROCK RD
BILLINGS, MT 59102
KITZENBERG, PAULA
3510 TIMBERLINE DR
BILLINGS, MT 59102
AGER, SHELLEE
3940 RIMROCK RD
BILLINGS, MT 59102
GAGE, JUDIE
1214 CRESTHAVEN WAY
BILLINGS, MT 59102
SPRING, LAUREN
50 27TH ST W
BILLINGS, MT 59102
SMITH, JOSEPH
50 27TH ST W
BILLINGS, MT 59102
HEMMER, LAWRENCE
2675 CENTRAL AVE
BILLINGS, MT 59102
WADE, JOHN
2345 KING AVE W
BILLINGS, MT 59102
Details
ERICA SCHUPPE, OT
Phone Number
(406) 259-1680
Office Locations
50 27TH ST W STE A
BILLINGS, MT 59102
50 27TH ST W STE A BILLINGS MT, 59102

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