Blue Advantage: Medicare Advantage Plan | Patrius Health - Patrius
Blue Advantage Plus Includes:
Blue Advantage Capital Includes:
Blue Advantage Magnolia Includes:
- Comprehensive Medical Coverage >
- Prescription Drug Coverage >
- Comprehensive Dental >
- Vision Exams & Eyewear >
- Hearing Exams & Hearing Aids >
- $0 premium
- $0 primary care physician copay
- $0 annual physical exam
- $0 copay for an annual routine vision and hearing exam
- $0 copay for most preventive services, most immunizations and lab services
- $750 allowance for preventive and comprehensive dental services per calendar year
- $290$230$185 eyewear allowance per calendar year
- Built-in prescription drug coverage
- No referral required for network specialists, doctors or hospitals
- In network and out of network covered services
- Significant discounts on hearing aids through TruHearing®*
- Air medical transportation**
Comprehensive Medical Coverage
More >Comprehensive Medical Coverage
NO referrals required to see specialists.
You can use providers outside the network.
NO COST for many health screenings, immunizations and other Medicare-recommended preventive services.
Prescription Drug Coverage
More >Prescription Drug Coverage
With Blue advantage you'll have access to a large network of pharmacies that make it convenient for you to save money.
Your drug cost savings are avaliable at retail pharmacies as well as through Mail-Order. Our Extensive PREFERRED pharmacy networks include Wal-Mart, Walgreens and many local independent neighborhood pharmacies!
Click here for ways to ensure you are paying the least amount for your prescriptions with Rx Savings Solutions.
Comprehensive & Preventive Dental
More >Comprehensive & Preventive Dental
Our Dental plan is designed to deliver care at an affordable price with no waiting period for Comprehensive and Preventive Services.
$1,000 allowance per calendar year for comprehensive and preventive dental.
Vision Exams & Eyewear
More >Vision Exams & Eyewear
$0 copay for annual routine vision exam.
$290$230$185 eyewear allowance per calendar year.
Hearing Exams & Hearing Aids
More >TruHearing® Services*
A comprehensive hearing care solution — $0 copay for an annual routine hearing exam, plus you can get state-of-the-art hearing aids as low as $499, $699 or $999 (one per ear, per year) which can save you thousands of dollars.
*All content ©2023 TruHearing, Inc. All Rights Reserved. TruHearing® is a registered trademark of TruHearing, Inc.
Over-the-Counter (OTC) Allowance
More >OTC
Allowance
Members are eligible for a $50 quarterly allowance to be used toward the purchase of over-the-counter (OTC) health and wellness products.
- $50 allowance available at the beginning of each quarter of the plan year (January, April, July and October)
- Allowance will be loaded to the FlexCard mailed to you at enrollment
- Any unused amount will not carry over to the next quarter
*The Patrius Health FlexCard Mastercard® Prepaid card is issued by Stride Bank, N.A., Member FDIC, pursuant to license by Mastercard International.
Blue Advantage makes it easy to stay healthy and save money
- $0 premium
- $0 primary care physician copay
- $0 annual physical exam
- $0 copay for an annual routine vision and hearing exam
- $0 copay for most preventive services, most immunizations and lab services
- $1,000 allowance for preventive and comprehensive dental services per calendar year
- $290$230$185 eyewear allowance per calendar year
- Built-in prescription drug coverage
- No referral required for network specialists, doctors or hospitals
- In network and out of network covered services
- Significant discounts on hearing aids through TruHearing®*
- Air medical transportation**
 |
Blue AdvantagePlus (PPO)$0 per monthView LIS Pricing >
Based on your income, you may qualify for financial help from Medicare to lower your monthly premium.* If you qualify, you will also have no drug coverage gap and lower out-of-pocket costs. If you aren't receiving extra help, the Mississippi State Health Insurance Assistance Program (SHIP) provides education and counseling on low-income assistance programs for Medicare. Mississippi Department of Human Services Division of Aging and Adult Services 1-601-359-4929 Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage. https://www.ssa.gov/benefits/medicare/prescriptionhelp
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. *You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. |
Blue AdvantageCapital (PPO)$0 per monthView LIS Pricing >
Based on your income, you may qualify for financial help from Medicare to lower your monthly premium.* If you qualify, you will also have no drug coverage gap and lower out-of-pocket costs. If you aren't receiving extra help, the Mississippi State Health Insurance Assistance Program (SHIP) provides education and counseling on low-income assistance programs for Medicare. Mississippi Department of Human Services Division of Aging and Adult Services 1-601-359-4929 Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage. https://www.ssa.gov/benefits/medicare/prescriptionhelp
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. *You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. |
Blue AdvantageMagnolia (PPO)$0 per monthView LIS Pricing >
Based on your income, you may qualify for financial help from Medicare to lower your monthly premium.* If you qualify, you will also have no drug coverage gap and lower out-of-pocket costs. If you aren't receiving extra help, the Mississippi State Health Insurance Assistance Program (SHIP) provides education and counseling on low-income assistance programs for Medicare. Mississippi Department of Human Services Division of Aging and Adult Services 1-601-359-4929 Medicare beneficiaries can qualify for Extra Help paying for their monthly premiums, annual deductibles, and co-payments related to Medicare prescription drug coverage. https://www.ssa.gov/benefits/medicare/prescriptionhelp
You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or your State Medicaid Office. *You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. |
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary Care Doctor Visit | $0 copay per visit | $0 copay per visit | $0 copay per visit | ||||||||||||||||||
| Specialist Visit | $25 copay per visit | $30 copay per visit | $25 copay per visit | ||||||||||||||||||
| Inpatient Hospital | $250 copay per day for days 1–7; You pay nothing per day for days 8-90; $0 copay for days 91 and after |
$235 copay per day for days 1–7; You pay nothing per day for days 8-90; $0 copay for days 91 and after |
$275 copay per day for days 1–7; You pay nothing per day for days 8-90; $0 copay for days 91 and after |
| Outpatient Hospital Services | $0-$200 copay | $0-$200 copay | $0-$200 copay |
| Lab Services | $0 copay | $0 copay | $0 copay |
| X-rays | $10 copay | $10 copay | $10 copay |
| Emergency Room Visit | $120 copay Waived if admitted |
$120 copay Waived if admitted |
$120 copay Waived if admitted |
| Ambulance | $200 copay per trip | $265 copay per trip | $250 copay per trip |
| Annual Physical Exam | $0 copay | $0 copay | $0 copay |
| Many Preventive Wellness Services | $0 copay | $0 copay | $0 copay |
| Durable Medical Equipment | 20% of cost | 20% of cost | 20% of cost |
| Telehealth Primary Care Physician | $0 copay per visit | $0 copay per visit | $0 copay per visit |
| Telehealth Specialist | $25 copay per visit | $30 copay per visit | $25 copay per visit |
| Diabetic Supplies* | $0 copay | $0 copay | $0 copay |
| Eye Exams | $0 copay for annual routine exam & $25 copay for diagnostic exam | $0 copay for annual routine exam & $30 copay for diagnostic exam | $0 copay for annual routine exam & $25 copay for diagnostic exam |
| Eyewear Allowance | $290 per calendar year | $230 per calendar year | $185 per calendar year |
| Preventive & Comprehensive Dental Allowance | $1,000 max per calendar year | $1,000 max per calendar year | $1,000 max per calendar year |
| Hearing Exams | $0 copay for annual routine exam with TruHearing provider $10 copay for diagnostic exam |
$0 copay for annual routine exam with TruHearing provider $10 copay for diagnostic exam |
$0 copay for annual routine exam with TruHearing provider $10 copay for diagnostic exam |
| Hearing Aids | $499/$699/$999 copay per hearing aid (one per ear, per year) |
$499/$699/$999 copay per hearing aid (one per ear, per year) |
$499/$699/$999 copay per hearing aid (one per ear, per year) |
Maximum Out-of-Pocket Amount
 This is the most an individual will pay in a year for eligible health services. After paying this amount, your insurance policy will pay for all other covered services. |
$4,900 (in-network) | $4,900 (in-network) | $4,900 (in-network) |
PREFERRED Cost-Sharing Pharmacy Copays
 A set fee you pay for a healthcare service, such as a visit to a doctor or hospital, or for a prescribed medication. The portion of the cost for healthcare that you will pay after you’ve met your deductible. For example, if you’ve met your deductible and your coinsurance is 20% and you receive a bill for $100, you’ll pay $20 and your insurance will pay the rest. |
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| Tier 1 - Preferred Generic | $0 | $0 | $0 |
| Tier 2 - Generic | $13 | $5 | $5 |
| Tier 3 - Preferred Brand | $40 | $40 | $40 |
| Tier 4 - Non-Preferred Brand | $93 | $93 | $93 |
| Tier 5 - Specialty Tier | 33% | 33% | 33% |
| Select Insulins (Tiers 3 & 4) | $35 | $35 | $35 |
| STANDARD Cost-Sharing Pharmacy Copays A set fee you pay for a healthcare service, such as a visit to a doctor or hospital, or for a prescribed medication. The portion of the cost for healthcare that you will pay after you’ve met your deductible. For example, if you’ve met your deductible and your coinsurance is 20% and you receive a bill for $100, you’ll pay $20 and your insurance will pay the rest. |
|||
| Tier 1 - Preferred Generic | $10 | $5 | $5 |
| Tier 2 - Generic | $20 | $15 | $15 |
| Tier 3 - Preferred Brand | $47 | $47 | $47 |
| Tier 4 - Non-Preferred Brand | $100 | $100 | $100 |
| Tier 5 - Specialty Tier | 33% | 33% | 33% |
| Select Insulins (Tiers 3 & 4) | $35 | $35 | $35 |
| Coverage Gap Phase | Once the TOTAL prescription annual spending exceeds $5,030 and YOUR spending is below $8,000 you pay 25% of generic drug costs and 25% of brand-name drug costs. | Once the TOTAL prescription annual spending exceeds $5,030 and YOUR spending is below $8,000 you pay 25% of generic drug costs and 25% of brand-name drug costs. | Once the TOTAL prescription annual spending exceeds $5,030 and YOUR spending is below $8,000 you pay 25% of generic drug costs and 25% of brand-name drug costs. |
| Catastrophic Coverage Phase | Once YOUR out-of-pocket spending on prescriptions reaches $8,000, you pay $0 for the rest of the calendar year. | Once YOUR out-of-pocket spending on prescriptions reaches $8,000, you pay $0 for the rest of the calendar year. | Once YOUR out-of-pocket spending on prescriptions reaches $8,000, you pay $0 for the rest of the calendar year. |
*Only Ascensia (Contour) and LifeScan (One-Touch) products are preferred with a $0 copay for up to 204 diabetic test strips for 30 days and glucometers at the pharmacy and through mail-order home delivery.
*TruHearing® is an independent company offering exclusive hearing aid savings for Patrius Health members. All content ©2023 TruHearing, Inc. All Rights Reserved. TruHearing® is a trademark of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners. Retail pricing based on prices for comparable aids. Follow-up provider visits included for one year following hearing aid purchase. Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees. For questions regarding fees, contact a TruHearing Hearing Consultant.
** Air medical transport services are provided through a contract with AirMed International, LCC, an independent company that does not provide Patrius Health, Inc. products. Patrius Health is not responsible for any mistakes, errors or omissions that AirMed, its employees or staff members make. Air medical services terminate if coverage by your health plan ends.
*** Out-of-network/non- contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our member services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
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