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Blue Cross Blue Shield Nebraska MA Connect (PPO)

H8181 - 002 - 0
4 out of 5 stars (4 / 5)

Blue Cross Blue Shield Nebraska MA Connect (PPO) is a Medicare Advantage Plan by Blue Cross and Blue Shield of Nebraska.

This page features plan details for 2025 Blue Cross Blue Shield Nebraska MA Connect (PPO) H8181 – 002 – 0 available in Omaha/ Lincoln Metro Area and Central Nebraska.

Locations

Blue Cross Blue Shield Nebraska MA Connect (PPO) is offered in the following locations.

Adams County, Nebraska
Antelope County, Nebraska
Arthur County, Nebraska

Click to see more locations

Plan Overview

Blue Cross Blue Shield Nebraska MA Connect (PPO) offers the following coverage and cost-sharing.

Insurer:Blue Cross and Blue Shield of Nebraska
Health Plan Deductible:$0
MOOP:$8,000 In and Out-of-network
$4,900 In-network
Drugs Covered:Yes

Ready to sign up for Blue Cross Blue Shield Nebraska MA Connect (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Blue Cross Blue Shield Nebraska MA Connect (PPO) qualifies for a monthly Medicare Give Back Benefit of $12.00.

Premium Reduction:$12.00

Premium Breakdown

Blue Cross Blue Shield Nebraska MA Connect (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $12.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Blue Cross Blue Shield Nebraska MA Connect (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Blue Cross Blue Shield Nebraska MA Connect (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • Out-of-Network: $30-350 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $30 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $195 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $195 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $30-350 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $20 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $25 copay (Authorization Required)

Doctor visits

  • Primary
    • Out-of-Network: $15 copay per visit
    • In-Network: $0 copay
  • Specialist
    • In-Network: $35 copay per visit
    • Out-of-Network: 50% coinsurance per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $55 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: 50% coinsurance
    • In-Network: $35 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • Out-of-Network: $350 copay
    • In-Network: $350 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Hearing aids
    • Out-of-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $0-35 copay
    • Out-of-Network: $15 copay or 50% coinsurance
  • Hearing aids
    • In-Network: $495-1,695 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • Out-of-Network: $400 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
    • In-Network: $400 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $8,000 In and Out-of-network
      $4,900 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • Out-of-Network: 0-20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • Out-of-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • Out-of-Network: $420 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $35 copay
  • Inpatient hospital – psychiatric
    • In-Network: $420 per day for days 1 through 4
      $0 per day for days 5 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $35 copay
    • Out-of-Network: $35 copay
  • Outpatient group therapy visit
    • Out-of-Network: $35 copay
  • Outpatient individual therapy visit
    • Out-of-Network: $35 copay
    • In-Network: $35 copay
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $35 copay
    • Out-of-Network: $35 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $350 copay per visit (Authorization Required)
    • Out-of-Network: $350 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $35 copay (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $196 per day for days 21 through 50
      $0 per day for days 51 through 100 (Authorization Required)
    • Out-of-Network: $0 per day for days 1 through 20
      $196 per day for days 21 through 65
      $0 per day for days 66 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Out-of-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Blue Cross Blue Shield Nebraska MA Connect (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Blue Cross Blue Shield Nebraska MA Connect (PPO)? See 2025 Blue Cross Blue Shield Nebraska MA Connect (PPO) at MedicareAdvantageRX.com.

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Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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