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HMO and PPO Plan Options Available

With Medicare Advantage plans from Blue Cross and Blue Shield of Nebraska you'll have predictable, easy-to-budget costs for doctor office visits, prescription drugs and more. Each plan offers a different level of benefits and out-of-pocket cost, so you can choose the one that is best suited to your needs.

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Hospital & Medical Benefits

Click for more details Medicare Advantage Core (HMO) Medicare Advantage Access (PPO) Medicare Advantage Choice (HMO-POS)
  When in and out-of-network costs are applicable, costs are listed as follows:
(In-Network/Out-of-Network)
Monthly Premium
n/a
$0 $26 $44
Travel Coverage  
Travel coverage means if you travel outside of the state you will be covered similar to in-state in-network benefits.
Yes Yes Yes
Maximum Out of Pocket Limit (In network / Combined In & Out network)  
Maximum out of pocket means the total amount you are responsible to pay for Medicare-covered services.
$6,250 $4,500 / $6,900 $5,700 / $6,700
Primary Care Doctor Visits  
This is your personally selected Physician to help guide your care.
$10 $5 / $15 $10
Acute Inpatient Hospital $395 per day for days 1-4
$0 per day for days 5+		 $395 per day for days 1-4
$0 per day for days 5+		 $380 per day for days 1-5
$0 per day for days 5+
Outpatient Hospital Surgery $300 per day $200 per day $200 per day
Urgent Care $55 $55 $55
Emergency Care $90 $90 $90
Inpatient Skilled Nursing Facility  
These facilites have the staff and equipment to give skilled nursing care or rehab services, they could be part of a hospital or nursing home.
$0 per day for days 1-20
$172 per day for days 21-59
$0 per day for days 60+		 $0 per day for days 1-20
$169 per day for days 21-48
$0 per day for days 49+		 $0 per day for days 1-20
$169 per day for days 21-55
$0 per day for days 56+
Routine Eye Exam  
Exam to diagnose diseases and conditions of the eye.
$10 $0 / 40% Coinsurance $0
Routine Hearing Exam  
Exam to diagnose hearing and balance problems.
$10 $0 $0
Over-the-Counter Allowance $25 per quarter $50 per quarter $25 per quarter
Dental Coverage Yes Yes Yes
Fitness Benefit  
Specialized fitness program designed for seniors.
SilverSneakers SilverSneakers SilverSneakers
Service Area Available in Adams, Buffalo, Burt, Butler, Cass, Colfax, Cuming, Dodge, Douglas, Gage, Hall, Hamilton, Johnson, Lancaster, Madison, Merrick, Nemaha, Otoe, Platte, Polk, Saline, Sarpy, Saunders, Seward, Washington, and York counties. Available in Burt, Butler, Cass, Colfax, Cuming, Dodge, Douglas, Gage, Lancaster, Otoe, Saline, Saunders, Sarpy, Seward and Washington counties

 

Prescription Drug Benefits

  Medicare Advantage Core (HMO) Medicare Advantage Access (PPO) Medicare Advantage Choice (HMO-POS)
30-day Retail Supply 90-day Mail Order 30-day Retail Supply 90-day Mail Order 30-day Retail Supply 90-day Mail Order
Preferred Cost Sharing Standard Cost Sharing Preferred Cost Sharing Standard Cost Sharing Preferred Cost Sharing Standard Cost Sharing
Tier 1: Preferred Generic Drugs $3 $14 $0 $0 $12 $0 $2 $12 $0
Tier 2: Generic Drugs $8 $18 $0 $8 $18 $0 $8 $18 $0
Tier 3: Preferred Brand Drugs $37 $47 $111 $37 $47 $111 $37 $47 $111
Tier 4: Non-Preferred Drugs 45% 45% 45% 45% 45% 45% 45% 45% 45%
Tier 5: Specialty Drugs 28% 28% N/A 31% 31% N/A 30% 30% N/A

 

Plan Information

Have Questions?
Getting Started?
Toll Free: 833-430-4643
(TTY 711)

 

Already a Member?
Toll Free: 888-488-9850
(TTY 711)

 

getstarted@nebraskablue.com

Request your Medicare Options Guide

Understanding all the coverage options available may feel confusing. Download our Blue Cross and Blue Shield of Nebraska Medicare options guide to review different products that are available and learn more about important dates to remember.

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