Medicare - Shop Our Insurance Plans
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| Northeast Region (Chase, Coffey, Douglas, Franklin, Geary, Jackson, Jefferson, Linn, Lyon, Miami, Morris, Osage, Pottawatomie, Riley, Shawnee and Wabaunsee counties) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
|---|---|---|---|
| General Costs* | |||
| Medical Benefit Copays | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
| Supplemental Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
| Prescription Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | |
| Monthly Premium | $0 | $50 | $0 |
| Deductible | No annual medical deductible | ||
| Out of Pocket Maximum (In Network) | $6,700 $5,700 | $6,200 $5,400 | $4,000 $3,000 |
| Out of Pocket Maximum (In Network and Out of Network) | $10,000 $8,900 | $9,000 $8,000 | $8,000 $5,400 |
| Primary Care Visit | $10 copay | $5 copay | $5 $0 copay |
| Specialist Visit | $50 copay | $40 copay | $25 copay |
| Emergency Care | $90 copay | $80 copay | $90 copay |
| Urgent Care | $30 copay | $25 copay | $20 copay |
| Ambulance | $250 copay | ||
| Inpatient Hospital - Acute | $300 copay per day for days 1 to 5 | $250 copay per day for days 1 to 5 | |
| Outpatient/Ambulatory Surgery | $250 copay | ||
| Diagnostic Procedures/Tests/Lab | $0 copay | ||
| Diagnostic X-Rays | $0 copay | ||
| Advanced Imaging (CTs/MRIs) | $50 to $250 copay | $40 to $250 copay | $25 to $250 copay |
| Mental Health Services | $40 copay | $40 copay | $25 $40 copay |
| Standard Out-of-Network† | 40% coinsurance | 30% coinsurance | 40% coinsurance |
| Dental | $500 $800 annual allowance for preventive services + comprehensive services | $800 $1,000 annual allowance for preventive services + comprehensive services | $900 $1,050 annual allowance for preventive services + minor comprehensive services |
| Optional: Comprehensive Dental | Add $21 premium - $1,000 allowance for minor comprehensive services | Not offered | |
| Vision | One routine eye exam + $150 eyewear allowance | ||
| Fitness | SilverSneakers® gym membership | Not offered | |
| Over-the-Counter (OTC) retail allowance | $140 per year ($35 per quarter) | $340 per year ($85 per quarter) | Not offered |
| Hearing | One routine hearing exam + discount on hearing aids + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 | ||
| Meals & Nutrition | Not offered 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | Not offered 14 home delivered meals over 7-day period post hospital discharge |
| Rx Deductible | No Rx deductible | No Rx deductible | $250 drug deductible on Tier 3-5 drugs. Tier 1 and Tier 2 drugs are not included in the deductibleTier 4 and 5 drugs |
| Retail | Standard | Standard | Standard |
| Tier 1 | $3 copay | $3 copay | $3 copay |
| Tier 2 | $5 copay | $5 copay | $5 copay |
| Tier 3 | $45 copay | $45 copay | $45 copay |
| Tier 4 | $100 copay | $100 copay | $100 copay |
| Tier 5 | 33% coinsurance | 33% coinsurance | 28% coinsurance |
| Mail Order | Standard | Standard | Standard |
| Tier 1 | $3 copay | $3 copay | $3 copay |
| Tier 2 | $5 copay | $5 copay | $5 copay |
| Tier 3 | $45 copay | $45 copay | $45 copay |
| Tier 4 | $100 copay | $100 copay | $100 copay |
| Tier 5 | 33% coinsurance | 33% coinsurance | 28% coinsurance |
| Medicare Advantage plans will be available starting October 15. | |||
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | |
| Summary of Benefits (PDF) | Blue Medicare Advantage (PPO) and Blue Medicare Advantage Comprehensive (PPO) 2023 Summary of Benefits | Blue Medicare Advantage Choice (PPO) 2023 Summary of Benefits | |
| Evidence of Coverage (PDF) | Blue Medicare Advantage (PPO) 2023 Evidence of Coverage | Blue Medicare Advantage Comprehensive (PPO) 2023 Evidence of Coverage | Blue Medicare Advantage Choice (PPO) 2023 Evidence of Coverage |
*Medicare Advantage benefits are based on a January 1, 2022 2023 effective date.
†Certain exceptions apply. Please reference the Evidence of Coverage for additional information.
| South Central Region (Butler, Cowley, Dickinson, Harvey, Kingman, Marion, McPherson, Reno, Sedgwick and Sumner counties) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
|---|---|---|---|
| General Costs* | |||
| Medical Benefit Copays | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
| Supplemental Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
| Prescription Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) |
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | |
| Monthly Premium | $0 | $40 | $0 |
| Deductible | No annual medical deductible | ||
| Out of Pocket Maximum (In Network) | $6,400 $5,400 | $5,900 $4,900 | $4,000 $3,000 |
| Out of Pocket Maximum (In Network and Out of Network) | $10,000 $8,900 | $9,000 $8,000 | $8,000 $5,400 |
| Primary Care Visit | $10 copay | $5 copay | $5 $0 copay |
| Specialist Visit | $45 copay | $40 copay | $25 copay |
| Emergency Care | $90 copay | $80 copay | $90 copay |
| Urgent Care | $30 copay | $25 copay | $20 copay |
| Ambulance | $250 copay | $200 copay | $250 copay |
| Inpatient Hospital - Acute | $300 copay per day for days 1 to 5 | $250 copay per day for days 1 to 5 | |
| Outpatient/Ambulatory Surgery | $250 copay | ||
| Diagnostic Procedures/Tests/Lab | $0 copay | ||
| Diagnostic X-Rays | $0 copay | ||
| Advanced Imaging (CTs/MRIs) | $45 to $250 copay | $40 to $250 copay | $25 to $250 copay |
| Mental Health Services | $40 copay | $40 copay | $25 $40 copay |
| Standard Out-of-Network† | 40% coinsurance | 30% coinsurance | 40% coinsurance |
| Dental | $1,000 $1,250 annual allowance for preventive services + comprehensive services | $2,000 $2,500 annual allowance for preventive services + comprehensive services | $900 $1,050 annual allowance for preventive services + minor comprehensive services |
| Vision | One routine eye exam + $150 eyewear allowance | ||
| Fitness | SilverSneakers® gym membership | Not offered | |
| Over-the-Counter (OTC) retail allowance | $140 per year ($35 per quarter) | $340 per year ($85 per quarter) | Not offered |
| Hearing | One routine hearing exam + discount on hearing aids + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 | ||
| Meals & Nutrition | Not offered 14 home delivered meals over 7-Day period post hospital discharge | 14 home delivered meals over 7-Day period post hospital discharge | Not offered 14 home delivered meals over 7-Day period post hospital discharge |
| Rx Deductible | No Rx deductible | No Rx deductible | $250 drug deductible on Tier 3-5 drugs. Tier 1 and Tier 2 drugs are not included in the deductible Tier 4 and 5 drugs |
| Retail | Standard | Standard | Standard |
| Tier 1 | $3 copay | $3 copay | $3 copay |
| Tier 2 | $5 copay | $5 copay | $5 copay |
| Tier 3 | $45 copay | $45 copay | $45 copay |
| Tier 4 | $100 copay | $100 copay | $100 copay |
| Tier 5 | 33% coinsurance | 33% coinsurance | 28% coinsurance |
| Mail Order | Standard | Standard | Standard |
| Tier 1 | $3 copay | $3 copay | $3 copay |
| Tier 2 | $5 copay | $5 copay | $5 copay |
| Tier 3 | $45 copay | $45 copay | $45 copay |
| Tier 4 | $100 copay | $100 copay | $100 copay |
| Tier 5 | 33% coinsurance | 33% coinsurance | 28% coinsurance |
| Medicare Advantage plans will be available starting October 15. | |||
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | |
| Summary of Benefits (PDF) | Blue Medicare Advantage (PPO) and Blue Medicare Advantage Comprehensive (PPO) 2023 Summary of Benefits | Blue Medicare Advantage Choice (PPO) 2023 Summary of Benefits | |
| Evidence of Coverage (PDF) | Blue Medicare Advantage (PPO) 2023 Evidence of Coverage | Blue Medicare Advantage Comprehensive (PPO) 2023 Evidence of Coverage | Blue Medicare Advantage Choice (PPO) 2023 Evidence of Coverage |
*Medicare Advantage benefits are based on a January 1, 2022 2023 effective date.
†Certain exceptions apply. Please reference the Evidence of Coverage for additional information.
| Benefits | Plan A | Plan G | Plan G (HDHP) | Plan G Select | Plan K | Plan K Select | Plan L | Plan N | Plan N Select |
|---|---|---|---|---|---|---|---|---|---|
| Plan A | Plan G | Plan G (HDHP) | Plan G Select | Plan K | Plan K Select | Plan L | Plan N | Plan N Select | |
| Monthly Sample Premium* | $115.55 $94.29 | $142.01 $124.72 | $61.34 $53.87 | $103.28 $106.01 | $66.31 $54.12 | $47.78 $46.00 | $89.47 $73.01 | $109.37 $89.24 | $79.14 $75.86 |
If you are a current Kansas Blue Medicare Supplement member and would like to change plans, please call us direct at 866-749-8290. | |||||||||
| Medicare Part A coinsurance and hospital coverage (up to an additional 365 days after Medicare benefits are used up) | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Medicare Part B coinsurance or copayment | ✔ | ✔ | ✔ | ✔ | 50% | 50% | 75% | ✔ | ✔ |
| Blood (first three pints each year) | ✔ | ✔ | ✔ | ✔ | 50% | 50% | 75% | ✔ | ✔ |
| Part A hospice care coinsurance or copayment | ✔ | ✔ | ✔ | ✔ | 50% | 50% | 75% | ✔ | ✔ |
| Skilled nursing facility coinsurance | ✔ | ✔ | ✔ | 50% | 50% | 75% | ✔ | ✔ | |
| Medicare Part A deductible | ✔ | ✔ | ✔ | 50% | 50% | 75% | ✔ | ✔ | |
| Medicare Part B excess charges | ✔ | ✔ | ✔ | ||||||
| Foreign travel emergency (up to plan limits) | ✔ | ✔ | ✔ | ✔ | ✔ | ||||
| Out-of-pocket limit | $6,620 $6,940 | $6,620 $6,940 | $3,310 $3,470 | ||||||
| After you pay this deductible | $2,490 $2,700 | ||||||||
| Monthly Sample Premium* | $115.55 $94.29 | $142.01 $124.72 | $61.34 $53.87 | $103.28 $106.01 | $66.31 $54.12 | $47.78 $46.00 | $89.47 $73.01 | $109.37 $89.24 | $79.14 $75.86 |
| Get accurate quote and enroll in a Medicare Supplement plan | |||||||||
*Medicare Supplement sample premiums are based on a 65-year-old female, non-tobacco user with household discount eligibility for January 1, 2022 2023 effective date.
BlueCross BlueShield Kansas Solutions also offers Medicare Supplement Plan C and F within our standard and select network. Plans C and F are only available to those eligible for Medicare before 01/01/2020. To review all plan coverages and a complete list of rates, please see our Outline of Coverages. Outline of Coverages.
Here is a list of key services not covered by any Medicare Supplement Plan:
- Custodial nursing home care.
- Intermediate nursing home care costs.
- Most dental care and hospital admissions for such care. Examples are treatment, filling, removal or replacement of teeth, root canal therapy, surgery for impacted teeth, and other surgical procedures involving the teeth or structures directly supporting the teeth.
- Routine physical examinations and tests, routine foot care, and immunizations except injection of pneumococcal vaccine, mammograms and prostate exams.
- Hearing aids and examinations for them, or consultations about them.
- Eyeglasses or contact lenses and examinations for them, or consultations about them, unless for replacement of the lens following cataract surgery.
- Benefits considered medically unnecessary by a committee of doctors representing Medicare and Blue Cross and Blue Shield of Kansas will not be paid.
Shop Medicare Part D plans
Blue Cross and Blue Shield of Kansas is a PPO plan with a Medicare contract. Enrollment in a Blue Cross and Blue Shield of Kansas Medicare Advantage plan depends on contract renewal. This information is not a complete description of benefits. Call 800-222-7645 (TTY:711) for more information.
Medicare Supplement is offered by BlueCross BlueShield Kansas Solutions, a wholly owned subsidiary of Blue Cross and Blue Shield of Kansas.
Not connected with or endorsed by the U.S. Government or federal Medicare program. By providing information BlueCross BlueShield Kansas Solutions or Blue Cross and Blue Shield of Kansas, a representative may contact you.
For costs and details of coverage, including exclusions, reductions or limitations and the terms under which the policy may be continued in force, call or write the company at 866-710-6641 (TTY 711) or BlueCross BlueShield Kansas Solutions, 1133 S.W. Topeka Blvd. Topeka, KS 66629-0001.
H7063_E23Web_M CMS Approved 06122019
Last updated 06/12/2019
e_7280abc 09/23