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BlueMedicare Preferred (PFFS)

H4213 - 017 - 5
3.5 out of 5 stars (3.5 / 5)

BlueMedicare Preferred (PFFS) is a Medicare Advantage Plan by Arkansas Blue Medicare.

This page features plan details for 2025 BlueMedicare Preferred (PFFS) H4213 – 017 – 5 available in Select Counties in Arkansas.

Locations

BlueMedicare Preferred (PFFS) is offered in the following locations.

Arkansas
Benton County, Arkansas
Carroll County, Arkansas

Click to see more locations

Plan Overview

BlueMedicare Preferred (PFFS) offers the following coverage and cost-sharing.

Insurer:Arkansas Blue Medicare
Health Plan Deductible:$1,000 Out-of-network
MOOP:$7,500 In and Out-of-network
Drugs Covered:Yes

Ready to sign up for BlueMedicare Preferred (PFFS) ?

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

Premium Breakdown

BlueMedicare Preferred (PFFS) has a monthly premium of $48.00. 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 $28.80 $19.20 $ $
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

BlueMedicare Preferred (PFFS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $490.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Basic 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
$19.20$0.00

Initial Coverage Phase

After you pay your $490.00 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 Basic Alternative benefit type.

Additional Benefits

BlueMedicare Preferred (PFFS) also provides the following benefits.

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

    • In-Network: No

Comprehensive Dental

  • Oral and Maxillofacial Surgery
    • In-Network: 20 Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: 20 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay
  • Prosthodontics, removable
    • In-Network: 20 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay
  • Restorative Services
    • In-Network: 20 Coins – No Co pay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $25-340 copay or 40% coinsurance
  • Diagnostic tests and procedures
    • In-Network: 0-20% coinsurance
  • Lab services
    • In-Network: 0-20% coinsurance
  • Outpatient x-rays
    • In-Network: 20% coinsurance
  • Lab services
    • Out-of-Network: 0-40% coinsurance
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $25-340 copay
  • Diagnostic tests and procedures
    • Out-of-Network: 0-40% coinsurance
  • Outpatient x-rays
    • Out-of-Network: 20-40% coinsurance

Doctor visits

  • Specialist
    • In-Network: $50 copay per visit
  • Primary
    • In-Network: $20 copay per visit
    • Out-of-Network: $20 copay or 40% coinsurance per visit
  • Specialist
    • Out-of-Network: $50 copay or 40% coinsurance per visit

Emergency care/Urgent care

  • Urgent care
    • $45 copay per visit (always covered)
  • Emergency
    • $110 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • Out-of-Network: $50 copay or 40% coinsurance
    • In-Network: $50 copay
  • Routine foot care
    • Not covered

Ground ambulance

    • Out-of-Network: $325 copay
    • In-Network: $325 copay

Health plan deductible

    • $1,000 Out-of-network

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay
    • Out-of-Network: $0 copay
  • Hearing aids
    • In-Network: $699-999 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $50 copay or 40% coinsurance
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $50 copay
  • Hearing aids
    • Out-of-Network: $699-999 copay (Limits Apply)

Inpatient hospital coverage

    • Out-of-Network: 40% per stay
      $390 per day for days 1 through 5
      $0 per day for days 6 through 90
    • In-Network: $390 per day for days 1 through 5
      $0 per day for days 6 through 90

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

    • $7,500 In and Out-of-network

Medical equipment/supplies

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

Medicare Part B drugs

  • Chemotherapy
    • Out-of-Network: $35 copay or 0-40% coinsurance
  • Other Part B drugs
    • Out-of-Network: $35 copay or 0-40% coinsurance
  • Chemotherapy
    • In-Network: 0-20% coinsurance
  • Other Part B drugs
    • In-Network: 0-20% coinsurance

Mental health services

  • Outpatient group therapy visit
    • In-Network: $35 copay
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $35 copay
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $35 copay or 40% coinsurance
  • Inpatient hospital – psychiatric
    • In-Network: $390 per day for days 1 through 5
      $0 per day for days 6 through 90
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $35 copay or 40% coinsurance
  • Inpatient hospital – psychiatric
    • Out-of-Network: 40% per stay
      $390 per day for days 1 through 5
      $0 per day for days 6 through 90
  • Outpatient group therapy visit
    • Out-of-Network: $35 copay or 40% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $35 copay
  • Outpatient individual therapy visit
    • In-Network: $35 copay
    • Out-of-Network: $35 copay or 40% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $340 copay per visit
    • Out-of-Network: $340 copay or 40% coinsurance per visit

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay or 40% coinsurance

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay
    • Out-of-Network: $35 copay or 40% coinsurance
  • Occupational therapy visit
    • In-Network: $35 copay
    • Out-of-Network: $35 copay or 40% coinsurance

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $203 per day for days 21 through 100
    • Out-of-Network: 40% per stay
      $0 per day for days 1 through 20
      $203 per day for days 21 through 100

Transportation

    • Not covered

Vision

  • Contact lenses
    • Not covered
  • Eyeglass lenses
    • Not covered
  • Other
    • Not covered
  • Eyeglasses (frames and lenses)
    • Not covered
  • Eyeglass frames
    • Not covered
  • Routine eye exam
    • Not covered
  • Upgrades
    • Not covered

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

    • Covered

Ready to sign up for BlueMedicare Preferred (PFFS) ?

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 BlueMedicare Preferred (PFFS)? See 2025 BlueMedicare Preferred (PFFS) at MedicareAdvantageRX.com.

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All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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