Medicare - Shop Our Insurance Plans
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Medicare Advantage Plans
You are newly eligible for Medicare and want Medicare Part C or you are switching during Annual Enrollment Period from Oct. 15 to Dec. 7.
Medicare Supplement Plans
You want to add a Medicare Supplement plan to your Original Medicare Parts A and B.
Medicare Part D Plans
You are newly eligible for Medicare Part D or you are switching during Annual Enrollment Period from Oct. 15 to Dec. 7.
Coverage year:
There are no Medicare Advantage plans available for your area.
Medicare Advantage plans are only available in the following counties in Kansas: Butler, Chase, Coffey, Cowley, Dickinson, Douglas, Franklin, Geary, Harvey, Jackson, Jefferson, Kingman, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Morris, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner and Wabaunsee.
| Blue Medicare Advantage (PPO) Northeast Region | Blue Medicare Advantage (PPO) South Central Region | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) | |
|---|---|---|---|---|---|
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | Enroll in Blue Medicare Advantage Freedom (PPO) | |
| General Costs* | |||||
| Monthly Premium | $0 | $0 | $40 | $0 | $0 |
| Deductible | No annual medical deductible | No annual medical deductible | No annual medical deductible | No annual medical deductible | No annual medical deductible |
| Out of Pocket Maximum (In Network) | $5,700 | $5,400 | $4,900 | $3,500 | $5,400 |
| Out of Pocket Maximum (In and Out of Network) | $8,900 | $8,900 | $8,000 | $5,400 | $8,950 |
| Medical Benefit Copays | Blue Medicare Advantage (PPO) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) |
| Primary Care Visit | $10 copay | $10 copay | $0 copay | $0 copay | $0 copay |
| Specialist Visit | $40 copay | $45 copay | $35 copay | $30 copay | $45 copay |
| Emergency Care | $90 copay | $90 copay | $90 copay | $90 copay | $95 copay |
| Urgent Care | $30 copay | $30 copay | $25 copay | $20 copay | $40 copay |
| Ambulance | $270 copay | $270 copay | $250 copay | $270 copay | $265 copay |
| Inpatient Hospital - Acute | $300 copay per day for days 1 to 5 | $300 copay per day for days 1 to 5 | $300 copay per day for days 1 to 5 | $295 copay per day for days 1 to 5 | $400 copay per day for days 1 to 5 |
| Outpatient/Ambulatory Surgery | $275 copay | $275 copay | $250 copay | $250 copay | $325 copay/$275 copay |
| Diagnostic Procedures/Tests/Lab | $0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
| Diagnostic X-Rays | $0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
| Advanced Imaging (CTs/MRIs) | $40 to $250 copay | $45 to $250 copay | $35 to $250 copay | $30 to $250 copay | $45 to $250 copay |
| Mental Health Services | $40 copay | $40 copay | $40 copay | $30 copay | $40 copay (outpatient) |
| Standard Out-of-Network† | 40% coinsurance | 40% coinsurance | 30% coinsurance | 40% coinsurance | 40% coinsurance |
| Supplemental Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) |
| Dental | $1,750 annual allowance for preventive services + comprehensive services | $2,500 annual allowance for preventive services + comprehensive services | $3,000 annual allowance for preventive services + comprehensive services | $1,750 annual allowance for preventive services + minor comprehensive services | $1,000 annual allowance for preventive services + comprehensive services |
| Optional: Comprehensive Dental | $1,000 allowance for minor comprehensive services (add $25 premium) | Not offered | $1,000 allowance for minor comprehensive services (add $25 premium) | Not offered | Not offered |
| Vision | One routine eye exam + $150 eyewear allowance | One routine eye exam + $150 eyewear allowance | One routine eye exam + $200 eyewear allowance | One routine eye exam + $200 eyewear allowance | One routine eye exam + $150 eyewear allowance |
| Fitness | SilverSneakers® gym membership | SilverSneakers® gym membership | SilverSneakers® gym membership | Not offered | SilverSneakers® gym membership |
| Over-the-Counter (OTC) Retail Allowance | $140 per year ($35 per quarter) | $140 per year ($35 per quarter) | $350 per year ($87.50 per quarter) | $200 per year ($50 per quarter) | $200 per year ($50 per quarter) |
| Hearing | One routine hearing exam + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 | One routine hearing exam + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 | One routine hearing exam + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 | One routine hearing exam + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 | One routine hearing exam + four-tier hearing aid offers at: $495, $895, $1,295 and $1,695 |
| Meals & Nutrition | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge |
| Prescription Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) |
| Rx Deductible | No Rx deductible | No Rx deductible | No Rx deductible | No Rx deductible | No Part D Coverage |
| Retail | Standard | Standard | Standard | Standard | No Part D Coverage |
| Tier 1 | $3 copay | $3 copay | $3 copay | $3 copay | No Part D Coverage |
| Tier 2 | $5 copay | $5 copay | $5 copay | $5 copay | No Part D Coverage |
| Tier 3 | $45 copay | $45 copay | $45 copay | $45 copay | No Part D Coverage |
| Tier 4 | $100 copay | $100 copay | $100 copay | $100 copay | No Part D Coverage |
| Tier 5 | 33% coinsurance | 33% coinsurance | 33% coinsurance | 33% coinsurance | No Part D Coverage |
| Mail Order | Standard | Standard | Standard | Standard | No Part D Coverage |
| Tier 1 | $0 copay | $0 copay | $0 copay | $0 copay | No Part D Coverage |
| Tier 2 | $0 copay | $0 copay | $0 copay | $0 copay | No Part D Coverage |
| Tier 3 | $90 copay | $90 copay | $90 copay | $90 copay | No Part D Coverage |
| Tier 4 | $300 copay | $300 copay | $300 copay | $300 copay | No Part D Coverage |
| Tier 5 | 33% coinsurance | 33% coinsurance | 33% coinsurance | 33% coinsurance | No Part D Coverage |
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | Enroll in Blue Medicare Advantage Freedom (PPO) | |
| Summary of Benefits (PDF) | Blue Medicare Advantage (PPO) 2024 Summary of Benefits | Blue Medicare Advantage (PPO) 2024 Summary of Benefits | Blue Medicare Advantage Comprehensive (PPO) 2024 Summary of Benefits | Blue Medicare Advantage Choice (PPO) 2024 Summary of Benefits | Blue Medicare Advantage Freedom (PPO) 2024 Summary of Benefit |
| Evidence of Coverage (PDF) | Blue Medicare Advantage (PPO) 2024 Evidence of Coverage | Blue Medicare Advantage (PPO) 2024 Evidence of Coverage | Blue Medicare Advantage Comprehensive (PPO) 2024 Evidence of Coverage | Blue Medicare Advantage Choice (PPO) 2024 Evidence of Coverage | Blue Medicare Advantage Freedom (PPO) 2024 Evidence of Coverage |
*Medicare Advantage benefits are based on a January 1, 2024 effective date.
†Certain exceptions apply. Please reference the Evidence of Coverage for additional information.
There are no Medicare Supplement plans available for your area.
Medicare Supplement plans are available in all Kansas counties except Johnson and Wyandotte.
| Benefits | 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* | $94.29 | $124.72 | $53.87 | $106.01 | $54.12 | $46.00 | $73.01 | $89.24 | $75.86 |
| Get your quote and enroll now 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 | $7,060 | $7,060 | $3,530 | ||||||
| After you pay this deductible | $2,800 | ||||||||
| Monthly Sample Premium* | $94.29 | $124.72 | $53.87 | $106.01 | $54.12 | $46.00 | $73.01 | $89.24 | $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, 2024 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 Coverage. « Non-select network MC918
To review all plan coverages and a complete list of rates, please see our Outline of Coverage. « Select network MC918S
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.
There are no Medicare Part D plans available for your area.
Medicare Part D plans are available in all Kansas counties except Johnson and Wyandotte.
Medicare Part D options: Shop for Medicare Part D plans
There are no Medicare Advantage plans available for your area.
Medicare Advantage plans are only available in the following counties in Kansas: Allen, Anderson, Bourbon, Butler, Chase, Chautauqua, Cherokee, Coffey, Cowley, Crawford, Dickinson, Douglas, Elk, Franklin, Geary, Greenwood, Harper, Harvey, Jackson, Jefferson, Kingman, Labette, Leavenworth, Linn, Lyon, Marion, McPherson, Miami, Montgomery, Morris, Neosho, Osage, Pottawatomie, Reno, Riley, Sedgwick, Shawnee, Sumner, Wabaunsee, Wilson, Woodson.
| Blue Medicare Advantage (PPO) Northeast Region | Blue Medicare Advantage (PPO) South Central Region | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) | |
|---|---|---|---|---|---|
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | Enroll in Blue Medicare Advantage Freedom (PPO) | |
| General Costs* | |||||
| Monthly Premium | $0 | $0 | $37 | $0 | $0 |
| Deductible | No annual medical deductible | No annual medical deductible | No annual medical deductible | No annual medical deductible | No annual medical deductible |
| Out of Pocket Maximum (In Network) | $5,200 | $5,200 | $4,900 | $3,500 | $5,400 |
| Out of Pocket Maximum (In and Out of Network) | $8,900 | $8,900 | $8,000 | $5,400 | $8,950 |
| Medical Benefit Copays | Blue Medicare Advantage (PPO) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) |
| Primary Care Visit | $5 copay | $5 copay | $0 copay | $0 copay | $0 copay |
| Specialist Visit | $40 copay | $40 copay | $35 copay | $30 copay | $45 copay |
| Emergency Care | $125 copay | $125 copay | $120 copay | $140 copay | $125 copay |
| Urgent Care | $30 copay | $30 copay | $25 copay | $20 copay | $40 copay |
| Ambulance | $300 copay | $300 copay | $300 copay | $300 copay | $300 copay |
| Inpatient Hospital - Acute | $330 copay per day for days 1 to 6 | $330 copay per day for days 1 to 6 | $295 copay per day for days 1 to 6 | $330 copay per day for days 1 to 6 | $400 copay per day for days 1 to 6 |
| Outpatient/Ambulatory Surgery | $275 copay | $275 copay | $250 copay | $250 copay | $325 copay/$275 copay |
| Diagnostic Procedures/Tests/Lab | $0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
| Diagnostic X-Rays | $0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
| Advanced Imaging (CTs/MRIs) | $40 to $250 copay | $45 to $250 copay | $35 to $250 copay | $30 to $250 copay | $45 to $250 copay |
| Mental Health Services | $40 copay | $40 copay | $40 copay | $30 copay | $40 copay (outpatient) |
| Standard Out-of-Network† | 40% coinsurance | 40% coinsurance | 30% coinsurance | 40% coinsurance | 40% coinsurance |
| Supplemental Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) |
| Dental | $2,500 annual allowance for preventive services + comprehensive services | $2,500 annual allowance for preventive services + comprehensive services | $3,000 annual allowance for preventive services + comprehensive services | $2,250 annual allowance for preventive services + comprehensive services | $1,000 annual allowance for preventive services + comprehensive services |
| Optional: Comprehensive Dental | $1,000 allowance for minor comprehensive services (add $25 premium) | Not offered | $1,000 allowance for minor comprehensive services (add $25 premium) | Not offered | Not offered |
| Vision | One routine eye exam + $250 eyewear allowance | One routine eye exam + $250 eyewear allowance | One routine eye exam + $200 eyewear allowance | One routine eye exam + $300 eyewear allowance | One routine eye exam + $150 eyewear allowance |
| Fitness | SilverSneakers® gym membership | SilverSneakers® gym membership | SilverSneakers® gym membership | Not offered | SilverSneakers® gym membership |
| Over-the-Counter (OTC) Retail Allowance | $140 per year ($35 per quarter) | $140 per year ($35 per quarter) | $350 per year ($87.50 per quarter) | $200 per year ($50 per quarter) | $200 per year ($50 per quarter) |
| Hearing | One routine hearing exam + four-tier hearing aid offers at: $295, $695, $1,095 and $1,495 | One routine hearing exam + four-tier hearing aid offers at: $295, $695, $1,095 and $1,495 | One routine hearing exam + four-tier hearing aid offers at: $295, $695, $1,095 and $1,495 | One routine hearing exam + four-tier hearing aid offers at: $295, $695, $1,095 and $1,495 | One routine hearing exam + four-tier hearing aid offers at: $295, $695, $1,095 and $1,495 |
| Meals & Nutrition | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge | 14 home delivered meals over 7-day period post hospital discharge |
| Prescription Benefits | Blue Medicare Advantage (PPO) | Blue Medicare Advantage (PPO) | Blue Medicare Advantage Comprehensive (PPO) | Blue Medicare Advantage Choice (PPO) | Blue Medicare Advantage Freedom (PPO) |
| Rx Deductible | No Rx deductible | No Rx deductible | No Rx deductible | No Rx deductible | No Part D Coverage |
| Retail | Standard | Standard | Standard | Standard | No Part D Coverage |
| Tier 1 | $0 copay | $0 copay | $0 copay | $0 copay | No Part D Coverage |
| Tier 2 | $5 copay | $5 copay | $5 copay | $5 copay | No Part D Coverage |
| Tier 3 | $42 copay | $42 copay | $42 copay | $42 copay | No Part D Coverage |
| Tier 4 | 31% coinsurance | 31% coinsurance | 31% coinsurance | 31% coinsurance | No Part D Coverage |
| Tier 5 | 33% coinsurance for 30-day supply | 33% coinsurance for 30-day supply | 33% coinsurance for 30-day supply | 33% coinsurance for 30-day supply | No Part D Coverage |
| Mail Order | Standard | Standard | Standard | Standard | No Part D Coverage |
| Tier 1 | $0 copay | $0 copay | $0 copay | $0 copay | No Part D Coverage |
| Tier 2 | $0 copay | $0 copay | $0 copay | $0 copay | No Part D Coverage |
| Tier 3 | $94 copay | $94 copay | $94 copay | $94 copay | No Part D Coverage |
| Tier 4 | 31% coinsurance | 31% coinsurance | 31% coinsurance | 31% coinsurance | No Part D Coverage |
| Tier 5 | 33% coinsurance for 30-day supply | 33% coinsurance for 30-day supply | 33% coinsurance for 30-day supply | 33% coinsurance for 30-day supply | No Part D Coverage |
| Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage (PPO) | Enroll in Blue Medicare Advantage Comprehensive (PPO) | Enroll in Blue Medicare Advantage Choice (PPO) | Enroll in Blue Medicare Advantage Freedom (PPO) | |
| Summary of Benefits (PDF) | Blue Medicare Advantage (PPO) 2025 Summary of Benefits | Blue Medicare Advantage (PPO) 2025 Summary of Benefits | Blue Medicare Advantage Comprehensive (PPO) 2025 Summary of Benefits | Blue Medicare Advantage Choice (PPO) 2025 Summary of Benefits | Blue Medicare Advantage Freedom (PPO) 2025 Summary of Benefit |
| Evidence of Coverage (PDF) | Blue Medicare Advantage (PPO) 2025 Evidence of Coverage | Blue Medicare Advantage (PPO) 2025 Evidence of Coverage | Blue Medicare Advantage Comprehensive (PPO) 2025 Evidence of Coverage | Blue Medicare Advantage Choice (PPO) 2025 Evidence of Coverage | Blue Medicare Advantage Freedom (PPO) 2025 Evidence of Coverage |
*Medicare Advantage benefits are based on a January 1, 2025 effective date.
†Certain exceptions apply. Please reference the Evidence of Coverage for additional information.
There are no Medicare Supplement plans available for your area.
Medicare Supplement plans are available in all Kansas counties except Johnson and Wyandotte.
| Benefits | 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* | $104.28 | $137.94 | $59.58 | $117.25 | $59.86 | $50.88 | $80.75 | $98.70 | $83.90 |
| Get your quote and enroll now 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 | $7,220 | $7,220 | $3,610 | ||||||
| After you pay this deductible | $2,870 | ||||||||
| Monthly Sample Premium* | $104.28 | $137.94 | $59.58 | $117.25 | $59.86 | $50.88 | $80.75 | $98.70 | $83.90 |
| 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, 2025 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 Coverage. « Non-select network MC918
To review all plan coverages and a complete list of rates, please see our Outline of Coverage. « Select network MC918S
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.
There are no Medicare Part D plans available for your area.
Medicare Part D plans are available in all Kansas counties except Johnson and Wyandotte.
| Blue MedicareRx Value (Basic) | Blue MedicareRx Plus (HCE) | Blue MedicareRx Essentials (LCE) | |
|---|---|---|---|
| Enroll in a Blue MedicareRx plan now | |||
| General Costs* | |||
| Monthly Premium | $39.60 | $61.60 | $0 |
| Deductible | $590 | No annual drug deductible | $425 |
| Deductible Exclusions | Tier 1 and Tier 2 excluded from deductible | N/A | Tier 1 and Tier 2 excluded from deductible |
| Out of Pocket Maximum | $2,000 | $2,000 | $2,000 |
| Drug Benefit Copays | Blue MedicareRx Value (Basic) | Blue MedicareRx Plus (HCE) | Blue MedicareRx Essentials (LCE) |
| Preferred Retail Cost Sharing (1 Month) | |||
| 1 Preferred Generic | $2 copay | $0 copay | $0 copay |
| 2 Generic | $4 copay | $0 copay | $2 copay |
| 3 Preferred Brand | 20% coinsurance | 20% coinsurance | 20% coinsurance |
| 4 Non-Preferred Drug | 48% coinsurance | 40% coinsurance | 48% coinsurance |
| 5 Specialty Tier† | 25% coinsurance | 33% coinsurance | 27% coinsurance |
| Standard Retail Cost Sharing (1 Month) | |||
| 1 Preferred Generic | $7 copay | $5 copay | $5 copay |
| 2 Generic | $9 copay | $7 copay | $7 copay |
| 3 Preferred Brand | 25% coinsurance | 25% coinsurance | 25% coinsurance |
| 4 Non-Preferred Drug | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| 5 Specialty Tier† | 25% coinsurance | 33% coinsurance | 27% coinsurance |
| Preferred Home Delivery (3 Months) | |||
| 1 Preferred Generic | $6 copay | $0 copay | $0 copay |
| 2 Generic | $12 copay | $0 copay | $4 copay |
| 3 Preferred Brand | 20% coinsurance | 20% coinsurance | 20% coinsurance |
| 4 Non-Preferred Drug | 48% coinsurance | 40% coinsurance | 48% coinsurance |
| 5 Specialty Tier† | 25% coinsurance - limited to 30-day supply | 33% coinsurance - limited to 30-day supply | 27% coinsurance - limited to 30-day supply |
| Standard Home Delivery (3 Months) | |||
| 1 Preferred Generic | $21 copay | $15 copay | $10 copay |
| 2 Generic | $27 copay | $21 copay | $14 copay |
| 3 Preferred Brand | 25% coinsurance | 25% coinsurance | 25% coinsurance |
| 4 Non-Preferred Drug | 50% coinsurance | 50% coinsurance | 50% coinsurance |
| 5 Specialty Tier† | 25% coinsurance - limited to 30-day supply | 33% coinsurance - limited to 30-day supply | 27% coinsurance - limited to 30-day supply |
| Insulin Coverage | Blue MedicareRx Value (Basic) | Blue MedicareRx Plus (HCE) | Blue MedicareRx Essentials (LCE) |
| Retail Cost Sharing (1 Month) | |||
| 3 Preferred Brand | No more than $35 copay per 30-day supply | No more than $35 copay per 30-day supply | No more than $35 copay per 30-day supply |
| 4 Non-Preferred Drug | No more than $35 copay per 30-day supply | No more than $35 copay per 30-day supply | No more than $35 copay per 30-day supply |
| Home Delivery (3 Months) | |||
| 3 Preferred Brand | No more than $105 copay per 90-day supply | No more than $105 copay per 90-day supply | No more than $105 copay per 90-day supply |
| 4 Non-Preferred Drug | No more than $105 copay per 90-day supply | No more than $105 copay per 90-day supply | No more than $105 copay per 90-day supply |
| Enroll in a Blue MedicareRx plan now | |||
| Summary of Benefits (PDF) | Blue MedicareRx Value (Basic) 2025 Summary of Benefits | Blue MedicareRx Plus (HCE) 2025 Summary of Benefits | Blue MedicareRx Essentials (LCE) 2025 Summary of Benefits |
| Evidence of Coverage (PDF) | Blue MedicareRx Value (Basic) 2025 Evidence of Coverage | Blue MedicareRx Plus (HCE) 2025 Evidence of Coverage | Blue MedicareRx Essentials (LCE) 2025 Evidence of Coverage |
*Part D benefits are based on a January 1, 2025 effective date.
†Certain exceptions apply. Please reference the Evidence of Coverage for additional information.
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
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