BlueMedicare Value (PFFS)
H4213 - 016 - 1
(3.5 / 5)
BlueMedicare Value (PFFS) is a Medicare Advantage Plan by Arkansas Blue Medicare.
This page features plan details for 2024 BlueMedicare Value (PFFS) H4213 – 016 – 1 available in Northern, Western and South Central AR counties.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
BlueMedicare Value (PFFS) is offered in the following locations.
Plan Overview
BlueMedicare Value (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: | No |
Ready to sign up for BlueMedicare Value (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 Value (PFFS) has a monthly premium of $29.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $29.00 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
BlueMedicare Value (PFFS) also provides the following benefits.
| $1,000 Out-of-network |
| In-network | No |
| $7,500 In and Out-of-network |
| No |
| In-network | No |
| In-network | $340 copay per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network | $340 copay or 40% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network Primary | $20 copay per visit (Not applicable.) (Not applicable.) |
| out-of-network Primary | $20 copay or 40% coinsurance per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | $50 copay per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | $50 copay or 40% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | $0 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| Emergency | $95 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $50 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | 0-20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Diagnostic tests and procedures | 0-40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Lab services | 0-20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Lab services | 0-40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $0-340 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | $0-340 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient x-rays | 20% coinsurance (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | 20-40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Hearing exam | $50 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing exam | $50 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Oral exam | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Cleaning | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Dental x-ray(s) | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Restorative services | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Restorative services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Periodontics | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Periodontics | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Extractions | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Extractions | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Prosthodontics, other oral/maxillofacial surgery, other services | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | 50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Routine eye exam | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| In-network Occupational therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | $40 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | $40 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network | $325 copay (Not applicable.) (Not applicable.) |
| out-of-network | $325 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Foot exams and treatment | $50 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | $50 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| out-of-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay per item (Authorization is not required.) (Not applicable.) |
| out-of-network Diabetes supplies | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| In-network Chemotherapy | 0-20% coinsurance (Authorization is not required.) (Not applicable.) |
| out-of-network Chemotherapy | $35 copay or 0-40% coinsurance (Authorization is not required.) (Not applicable.) |
| In-network Other Part B drugs | 0-20% coinsurance (Authorization is not required.) (Not applicable.) |
| out-of-network Other Part B drugs | $35 copay or 0-40% coinsurance (Authorization is not required.) (Not applicable.) |
| In-network Part B Insulin drugs | $35 copay (Authorization is not required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | $35 copay or 0-40% coinsurance (Authorization is not required.) (Not applicable.) |
| In-network | $390 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.) |
| out-of-network | 40% per stay $390 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | $385 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | 40% per stay $385 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $35 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | $35 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $35 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | $35 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $35 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | $35 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $35 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | $35 copay or 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network | $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.) |
| out-of-network | 40% per stay $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.) |
Ready to sign up for BlueMedicare Value (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
Table of Contents
Need more information on BlueMedicare Value (PFFS)? See 2025 BlueMedicare Value (PFFS) 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
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
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