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With this option, there is a $35 copay for the initial office visit, then $150 inpatient hospital copay per day up to $750 maximum. Deductible: Copay Enabled: Saturday, July 21, 2012 Rider. Please call Florida Blue at the help number listed on this website and read them the message on your screen, including the Application ID. With a variety of Blue Options everyday health plans, Blue Options all copay plans, and Blue Options essential plans, most people can find excellent coverage that works with their budget. Florida Blue Options PPO Health Insurance Plans The main advantage of these. STATE OF FL Employees’ PPO Coverage Period: 01/01/20 21- 12/31/20 Standard PPO Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage for: Individual and/or Family Plan Type: Standard PPO Page 1 of 7 The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. . Florida Blue is a PPO Plan with a Medicare contract. Enrollment in Florida Blue depends on contract renewal. You pay a $0 copay per visit. Level 2 Primary care visits: You pay a $10 copay per visit. Level 1 Specialist care visits: You pay a $35 copay per visit. If you are a Florida Blue member, you can also obtain your current SBC anytime by logging into the Florida Blue Member Portal. Use the Search box below to search for an SBC by Group Number or Plan Number. If you are unable to locate your SBC, or wish to have an SBC sent to you free of charge, call 1-800-352-2583.
BlueMedicare Patriot (PPO) H5434-038 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Florida Blue available to residents in Florida. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The BlueMedicare Patriot (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,900 out of pocket. This can be a extremely nice safety net.
BlueMedicare Patriot (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Florida Blue works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueMedicare Patriot (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Florida Blue except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 Florida Blue Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H5434-038 |
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| Provider: | Florida Blue |
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| Year: | 2021 |
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| Type: | Local PPO * |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: |
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| MOOP: | $5,900 |
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| Similar Plan: | H5434-002 |
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2021 BlueMedicare Patriot (PPO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | 50% coinsurance (Out-of-Network) |
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| Extractions | $0 copay |
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| Non-routine services | Not covered |
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| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | 50% coinsurance (Out-of-Network) |
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| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
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| Restorative services | Not covered |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | 50% coinsurance (Out-of-Network) |
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| Diagnostic radiology services (e.g., MRI) | $0-75 copay |
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| Diagnostic tests and procedures | $0-75 copay |
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| Diagnostic tests and procedures | 50% coinsurance (Out-of-Network) |
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| Lab services | $0-40 copay |
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| Lab services | 50% coinsurance (Out-of-Network) |
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| Outpatient x-rays | 50% coinsurance (Out-of-Network) |
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| Outpatient x-rays | $15-150 copay |
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Doctor Visits
| Primary | $10 copay per visit |
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| Primary | 50% coinsurance per visit (Out-of-Network) |
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| Specialist | 50% coinsurance per visit (Out-of-Network) |
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| Specialist | $45 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $30 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | 50% coinsurance (Out-of-Network) |
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| Foot exams and treatment | $35 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
| $250 copay |
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| $250 copay (Out-of-Network) |
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Hearing
| Fitting/evaluation | $0 copay |
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| Fitting/evaluation | 50% coinsurance (Out-of-Network) |
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| Hearing aids | 50% coinsurance (Out-of-Network) |
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| Hearing aids | $0 copay |
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| Hearing exam | $45 copay |
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| Hearing exam | 50% coinsurance (Out-of-Network) |
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Inpatient Hospital Coverage
| 50% per stay (Out-of-Network) |
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$375 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond |
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Medical Equipment/Supplies
| Diabetes supplies | 50% coinsurance per item (Out-of-Network) |
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| Diabetes supplies | $0 copay |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 50% coinsurance per item (Out-of-Network) |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 50% coinsurance per item (Out-of-Network) |
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Medicare Part B Drugs
| Chemotherapy | 50% coinsurance (Out-of-Network) |
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| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 50% coinsurance (Out-of-Network) |
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| Other Part B drugs | $5 copay or 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | 50% per stay (Out-of-Network) |
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| Inpatient hospital - psychiatric | $318 per day for days 1 through 5
$0 per day for days 6 through 90 |
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| Outpatient group therapy visit | 50% coinsurance (Out-of-Network) |
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| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
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| Outpatient individual therapy visit | 50% coinsurance (Out-of-Network) |
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| Outpatient individual therapy visit | $40 copay |
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| Outpatient individual therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
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| Outpatient individual therapy visit with a psychiatrist | $40 copay |
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MOOP
$10,000 In and Out-of-network
$5,900 In-network |
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Option
Optional supplemental benefits
Outpatient Hospital Coverage
| 50% coinsurance per visit (Out-of-Network) |
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| $350 copay per visit |
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Preventive Care
| 50% coinsurance (Out-of-Network) |
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| $0 copay |
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Preventive Dental
| Cleaning | $0 copay |
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| Cleaning | 50% coinsurance (Out-of-Network) |
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| Dental x-ray(s) | 50% coinsurance (Out-of-Network) |
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| Dental x-ray(s) | $0 copay |
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| Fluoride treatment | Not covered |
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| Oral exam | 50% coinsurance (Out-of-Network) |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $40 copay |
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| Occupational therapy visit | 50% coinsurance (Out-of-Network) |
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| Physical therapy and speech and language therapy visit | $40 copay |
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| Physical therapy and speech and language therapy visit | 50% coinsurance (Out-of-Network) |
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Skilled Nursing Facility
| 50% per stay (Out-of-Network) |
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$0 per day for days 1 through 20
$160 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | 50% coinsurance (Out-of-Network) |
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| Contact lenses | $0 copay |
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| Eyeglass frames | $0 copay |
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| Eyeglass frames | 50% coinsurance (Out-of-Network) |
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| Eyeglass lenses | 50% coinsurance (Out-of-Network) |
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| Eyeglass lenses | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Eyeglasses (frames and lenses) | 50% coinsurance (Out-of-Network) |
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| Other | Not covered |
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| Routine eye exam | 50% coinsurance (Out-of-Network) |
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| Routine eye exam | $0 copay |
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| Upgrades | Not covered |
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Wellness Programs (e.g. fitness nursing hotline)
Reviews for BlueMedicare Patriot (PPO) H5434
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
|---|
| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
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| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
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Member Experience with Health Plan
| Total Experience Rating |
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| Getting Needed Care |
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| Customer Service |
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| Health Care Quality |
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| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in BlueMedicare Patriot (PPO) Plans Performance
| Total Rating |
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| Complaints about Health Plan |
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| Members Leaving the Plan |
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| Health Plan Quality Improvement |
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| Timely Decisions About Appeals |
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Health Plan Customer Service Rating for BlueMedicare Patriot (PPO)
| Total Customer Service Rating |
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| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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BlueMedicare Patriot (PPO) Drug Plan Customer Service Ratings
| Total Rating |
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| Call Center, TTY, Foreign Language |
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| Appeals Auto |
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| Appeals Upheld |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
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| Statin with Diabetes |
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Florida Blue Ppo Insurance
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Florida Blue Ppo Copay
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for BlueMedicare Patriot (PPO)
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Florida Blue Ppo Health Insurance
Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
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