4

4 out of 5 stars* for plan year 2024

Plan ID: H3404-003

What You Need to Know:

  • Blue Medicare PPO Enhanced (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $59, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $5,900 per year (in-network).
  • Blue Medicare PPO Enhanced (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $47.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$59

Monthly Premium

Medicare Plan Features
Monthly Premium: $59.00
Part C Premium: $12.00
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$59.00 $12.00 $47.00 $0 $47.00 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3404-003
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $5,900
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Person, North Carolina: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
57 members 4 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,069 drugs
Number of Members Enrolled in this Plan in Person, North Carolina: 21,566 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$22.00 $47.00 $0.00 $69.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$38.70 $39.40 $61.40 $31.80 $53.80 $24.20 $46.20
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
142 $0.00 543 $6.00 773 $37.00 725 45% 677 33%

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Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,500$-
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HumanaChoice R1390-002 (Regional PPO) (2023)Regional PPO$7,550$360
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WellCare Value (HMO) (2023)Local HMO$5,500$150
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Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
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HumanaChoice H5216-211 (PPO) (2023)Local PPO$6,700$160
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Humana Gold Plus H1036-291 (HMO) (2023)Local HMO$3,900$0
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HumanaChoice R1390-001 (Regional PPO) (2023)Regional PPO *$5,400$-
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Blue Medicare Essential Plus (HMO) (2023)Local HMO$4,200$195
5
WellCare Patriot (PPO) (2023)Local PPO *$5,500$-
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Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$3,600$50
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Blue Medicare Enhanced (HMO) (2023)Local HMO$3,900$0
5
Medicare Advantage Plans by Blue Cross and Blue Shield of North Carolina
Blue Medicare Medical Only (HMO) (2023)Local HMO *$4,400$-
5
Blue Medicare Essential Plus (HMO) (2023)Local HMO$4,200$195
5
Blue Medicare Enhanced (HMO) (2023)Local HMO$3,900$0
5

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