diagnostic radiology services (not including X-rays), Cervical and Vaginal Cancer Screening (Pap Test and Pelvic Exam), Personalized Prevention Plan Services (Annual Wellness Visits), Prostate Cancer Screening (Prostate Specific Antigen (PSA) test only), Smoking Cessation (Counseling to stop smoking), Welcome to Medicare Physical Exam (Initial Preventive Physical Exam). There is no limit to the number of benefit periods you can have.". Covered once a year for women with Medicare at high risk. Specified copayment for outpatient hospital facility emergency services. HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. If you visit a doctor outside of your network, you may have to pay more for your care. Plan covers up to 100 days each benefit period. In 2012 the monthly Part B Standard Premium is. Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. Platinum Blue Complete Plan (Cost) (H2461-007) by Blue Cross and Blue Shield of Minnesota - Freeborn County, MN National and regional plans offer you choices of different cost-sharing arrangements, premiums and networks. Specified cost sharing for program services provided by hospital outpatient departments. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. Specified copayment for outpatient partial hospitalization program services furnished by a hospital or community mental health center (CMHC). You may go to any doctor specialist or hospital that accepts Medicare. The Platinum Blue plan includes: Access to a large provider network of doctors, clinics and hospitals. You must pay the inpatient hospital deductible for each benefit period. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan or you can get all your Medicare coverage including prescription drug coverage by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. You don't have to pay the emergency room copay if you are admitted to the hospital as an inpatient for the same condition within 3 days of the emergency room visit. If you go into the hospital after one benefit period has ended a new benefit period begins. Smoking Cessation (counseling to stop smoking). Preventive dental services (such as cleaning) not covered. Covered once a year for all men with Medicare over age 50. Your doctor's visit costs $100. Pneumococcal Vaccine. If you go to out-of-network doctors the plan may not cover the services but Medicare will pay its share for Medicare-covered services When Medicare pays its share you pay the Medicare Part B deductible and coinsurance. Find a Plan Disclaimer: The estimated and maximum costs displayed should be used for plan comparison purposes only.These amounts are provided simply to allow you to see how the different plans work in sample situations. You may only need the Pneumonia vaccine once in your lifetime. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. Details Drug Coverage for the Blue Cross and Blue Shield of Minnesota Platinum Blue Complete Plan with Rx H2461-010 (Cost) in Minnesota. Pediatric Dental Benefits. Search for low-cost generic alternatives, specialty medications, and medications that have $0 copays . Supplemental routine eye exams and glasses not covered. Silver plans are the only plans that offer cost sharing discounts. Silver plans have a higher monthly premium and often lower out-of-pocket costs than bronze plans. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or apply for help at your State Medical Assistance (Medicaid) office. Copay cannot exceed the Part A inpatient hospital deductible. During the first 12 months of your new Part B coverage you can get either a Welcome to Medicare Physical Exam or an Annual Wellness Visit. Medicare Advantage with Part D plan details and help for Platinum Blue Complete Plan with Rx (Cost) offered by Blue Cross and Blue Shield of Minnesota. Specified copayment for outpatient hospital facility emergency services. You must get care from a Medicare-certified hospice. """Partial hospitalization program"" is a structured program of active outpatient psychiatric treatment that is more intense than the care received in your doctor's or therapist's office and is an alternative to inpatient hospitalization.". However some people will pay a higher premium because of their yearly income (over. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan www.blueshieldca.com or by calling 1 -888 256 3650. Blue Cross is discontinuing its Blue Choice Platinum and Blue Access Gold plans at the end of the year. HIV screening is covered for people with Medicare who are pregnant and people at increased risk for the infection including anyone who asks for the test. You also don’t need to name one doctor as your primary care provider (PCP) or receive referrals to see a specialist. You pay 30% ($30). This limitation does not apply to inpatient psychiatric services furnished in a general hospital. Medicare covers this test once every 12 months or up to three times during a pregnancy. Hepatitis B Vaccine for people with Medicare who are at risk. No referral required for network doctors specialists and hospitals. View plan details below. Diagnostic Tests X-Rays Lab Services and Radiology Services, Cardiac and Pulmonary Rehabilitation Services, Preventive Services and Wellness/Education Programs. If you go into the hospital after one benefit period has ended a new benefit period begins. However some people will pay a higher premium because of their yearly income (over. In some cases, you may have to pay the full cost. If you go into the hospital after one benefit period has ended a new benefit period begins. The right plan depends on how often you visit the doctor or pharmacy and how much you want to pay monthly versus paying when you get care. Supplemental routine hearing exams and hearing aids not covered. In 2012 the amounts for each benefit period are: Call 1-800-MEDICARE (1-800-633-4227) for information about lifetime reserve days. Help is available. Annual glaucoma screenings covered for people at risk. There is no limit to the number of benefit periods you can have.". The choice is always yours to make, but you may be responsible for much higher out-of-pocket costs when you seek care out of the PPO network. Lifetime reserve days can only be used once. Medicare covers this test once every 12 months or up to three times during a pregnancy. Medicare-covered podiatry benefits are for medically-necessary foot care. This limitation does not apply to inpatient psychiatric services furnished in a general hospital. This plan does not offer prescription drug coverage. BCBSIL is the leader in Platinum health insurance plans in Illinois. Your plan will pay for a consultative visit before you select hospice. This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $4,000 this can be a very nice safety net. Emergency services copay cannot exceed Part A inpatient hospital deductible for each service provided by the hospital. Please note, all premiums listed represent coverage for dependents up to age 26. yearly drug costs reach $4,1301 25% of the plan’s costs for covered generic drugs; no more than 25% of the plan’s costs for covered brand-name drugs Catastrophic coverage Amount you pay after your total yearly out-of-pocket drug costs reach $6,5502 For all plans, you pay the greater of: … Includes two counseling attempts within a 12-month period. prescription drug coverage costs. In general preventive dental benefits (such as cleaning) not covered. Plan covers you when you travel in the U.S. No limit to the number of days covered by the plan each hospital stay. No referral required for network doctors specialists and hospitals. These services can be given by a registered dietitian and may include a nutritional assessment and counseling to help you manage your diabetes or kidney disease. Medicare covers screening mammograms once every 12 months for all women with Medicare age 40 and older. This is a 4-star Medicare Advantage plan. Enrollment in these plans depends on the plan’s contract renewal with Medicare. The $30 you paid was applied toward your coinsurance. Our Platinum plans contain our plans with the highest premiums and are designed to include the lowest cost sharing (deductible and copays) compared to other plans. There may be limits on physical therapy occupational therapy and speech and language pathology services If so there may be exceptions to these limits. You can add prescription drug coverage to Original Medicare by joining a Medicare Prescription Drug Plan or you can get all your Medicare coverage including prescription drug coverage by joining a Medicare Advantage Plan or a Medicare Cost Plan that offers prescription drug coverage. Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning On or After 1/1/2018 Blue Shield Platinum 90 PPO 0/15 + Child Dental INF Coverage for: Individual + Family | Plan Type: PPO 1 of 9 Blue Shield of California is an independent member of the Blue Shield Association. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. "A ""benefit period"" starts the day you go into a hospital or skilled nursing facility. Specified copayment for outpatient hospital facility services Copay cannot exceed the Part A inpatient hospital deductible. 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