Blue Cross Medicare Advantage Select (HMO)

Medicare Advantage Plan for New Mexico

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderBlue Cross Blue Shield of New Mexico
Plan IDH3251-2-0
CMS Rating1
Plan TypeHMO
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 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)
  • was the 4th best selling plan in Bernalillo in 2018

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)
$6,400 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
$350 for days 1 through 5
$0 for days 6 through 90
Outpatient hospital coverage
$0-300 per visit
Doctor visits
Primary:
$0 copay
Specialist:
$50 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$20 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$0-50
Lab services:
$5-50
Diagnostic radiology services (e.g., MRI):
$325-375
Outpatient x-rays:
$10-100
Mental health services
$324 for days 1 through 5
$0 for days 6 through 90
Outpatient group therapy visit with a psychiatrist:
$25
Outpatient individual therapy visit with a psychiatrist:
$25
Outpatient group therapy visit:
$25
Outpatient individual therapy visit:
$25
Skilled Nursing Facility
$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
$300
Transportation
$0 copay
Foot care (podiatry services)
Foot exams and treatment:
$50
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:
0-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for Blue Cross Medicare Advantage Select (HMO)

StateNew Mexico
CountyBernalillo

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
Improving or maintaining mental health
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
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 Blue Cross Medicare Advantage Select (HMO) for New Mexico

/
DOZEMAN, LYNN
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
BUXTON, BENJAMIN
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
TAM, ADELA
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
CANDELARIA, DELFINO
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
FETNER, JEAN
8901 BLUEWATER RD NW
ALBUQUERQUE, NM 87121
HAWKES, ELIZABETH
2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM 87105
MILLER, FREDERICK
2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM 87105
VIGIL, KRISTINE
1245 ISLETA BLVD SW
ALBUQUERQUE, NM 87105
SHELLEY, BRIAN
2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM 87105
JACOBSOHN, VANESSA COOK
2001 EL CENTRO FAMILIAR BLVD SW
ALBUQUERQUE, NM 87105
JANSEN, SHARI
2701 DON FELIPE RD SW
ALBUQUERQUE, NM 87105
CHRISMAN, SUSAN
501 57TH ST NW
ALBUQUERQUE, NM 87105
BUCKELS, WENDY
2410 VENETIAN WAY SW
ALBUQUERQUE, NM 87105
DUARTE, RAMON
4201 CENTRAL AVE NW
ALBUQUERQUE, NM 87105
FU, REBEKAH
3436 ISLETA BLVD SW
ALBUQUERQUE, NM 87105
GUTTMAN, JOHN
200 RIO BRAVO BLVD SE
ALBUQUERQUE, NM 87105
ALKON, LIAT
2220 RAYMAC RD SW
ALBUQUERQUE, NM 87105
FELIX, ROGER
12127B HWY 14 N
CEDAR CREST, NM 87008
Details
LYNN DOZEMAN, MD
Phone Number
(505) 831-2534
Office Locations
6900 GONZALES RD SW
ALBUQUERQUE, NM 87121
6900 GONZALES RD SW ALBUQUERQUE NM, 87121

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