Medicare Advantage Plans

Blue Cross Medicare Advantage
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Blue Cross Medicare AdvantageSM plans can be seen as an all-in-one option and offers:

  • Original Medicare coverage
  • Additional benefits and services not covered by Original Medicare or most Medicare Supplement Insurance Plans
  • Built-in Prescription Drug coverage

Whether you're new to Medicare or making a change, here are some things to consider before choosing your plan.

  • Be sure you are eligible for Medicare.
  • If you'd like to enroll in a Medicare Advantage plan, make sure you're aware of enrollment periods. Members may enroll in the plan only during specific times of the year.
  • You must live in one of the following counties:
    • HMO plans are available in Canadian, Cleveland, Creek, Grady, Lincoln, Logan, Mayes, McClain, Muskogee, Oklahoma, Okmulgee, Payne, Pottawatomie, Rogers, and Tulsa counties.
    • PPO plans are available in Canadian, Cleveland, Comanche, Garfield, Grady, Lincoln, Logan, McClain, Oklahoma, and Pottawatomie counties.
  • Review the 2015 plan benefits and built-in drug coverage below.





Select a plan name below to view 2015 plan information.

OK Medicare Tables
OKC Basic HMO OKC Premier Plus HMO-POS OKC Choice Plus PPO Tulsa Basic HMO Tulsa Premier Plus HMO-POS
2015 Blue Cross Medicare Advantage Plans
Blue Cross Medicare Advantage Basic (HMO)SM
Monthly Premium
$0
In-Network
Medical Deductible
$0
Doctors Office Visits

$5 Primary Care
$40 Physician Specialist
Maximum Out-of-Pocket
$4,500
Over-the-Counter Items Monthly Purchase Allowance*
$10
Dental
Preventive - Covered
Comprehensive - Not Covered
Diabetic Test Strips
0%
0% Other Diabetic Supplies
Outpatient Services/Surgery
$250
Skilled Nursing Facility
$0 copay (days 1-20); $150 copay (days 21-100)
Gap Coverage
You'll pay $0 / $5 for drugs in Tier 1 and $6/$11 for drugs in Tier 2. Otherwise, you'll pay 45% of the cost of Brand Name drugs and 65% of the cost of Generic drugs on Tiers 3, 4 and 5.
SilverSneakers® Fitness Program
$0
Travel Out of Service Area
Covered
Prescription Copays and Coinsurances
Preferred Pharmacy
Standard
Annual Prescription Deductible
$0
$0
Tier 1 - Preferred Generic Drugs
$0
$5
Tier 2 - Standard Generic Drugs
$6
$11
Tier 3 - Preferred Brand Drugs
$39
$44
Tier 4 - Standard Brand Drugs
$85
$95
Tier 5 - Specialty Drugs
33% of the cost
33% of the cost
Annual Notice of Change
Evidence of Coverage
Summary of Benefits

2015 Blue Cross Medicare Advantage Plans
Blue Cross Medicare Advantage Premier Plus (HMO-POS)SM
Monthly Premium
$39
In-Network
Out-of-Network
Medical Deductible
$0
$0
Doctors Office Visits
$10 Primary Care
$50 Primary Care
$45 Physician Specialist
$50 Physician Specialist
Maximum Out-of-Pocket
$4,900
No Limit on OOP Maximum
Over-the-Counter Items Monthly Purchase Allowance*
$20
Dental
Preventive - Covered
Preventive - Not Covered
Comprehensive - Covered
Comprehensive - Not Covered
Diabetic Test Strips
0%
0% Other Diabetic Supplies
Outpatient Services/Surgery
$250
40%
Skilled Nursing Facility
$0 copay (days 1-20); $150 copay (days 21-100)
40%
Gap Coverage
You'll pay $0 / $5 for drugs in Tier 1 and $6/$11 for drugs in Tier 2. Otherwise, you'll pay 45% of the cost of Brand Name drugs and 65% of the cost of Generic drugs on Tiers 3, 4 and 5.
SilverSneakers® Fitness Program
$0
$0
Travel Out of Service Area
Covered
Covered
Prescription Copays and Coinsurances
Preferred Pharmacy
Standard
Annual Prescription Deductible
$0
$0
Tier 1 - Preferred Generic Drugs
$0
$5
Tier 2 - Standard Generic Drugs
$6
$11
Tier 3 - Preferred Brand Drugs
$39
$44
Tier 4 - Standard Brand Drugs
$85
$95
Tier 5 - Specialty Drugs
33% of the cost
33% of the cost
Annual Notice of Change
Evidence of Coverage
Summary of Benefits

2015 Blue Cross Medicare Advantage Plans
Blue Cross Medicare Advantage Choice Plus (PPO)SM
Monthly Premium
$55
In-Network
Out-of-Network
Medical Deductible
$0
$0
Doctors Office Visits
$20 Primary Care
30% Primary Care
$40 Physician Specialist
30% Physician Specialist
Maximum Out-of-Pocket
$3,400
$5,000
Dental
Preventive - Covered
Comprehensive - Not Covered
Preventive - Covered
Comprehensive - Not Covered
Routine Vision
Covered
Covered
Diabetic Test Strips
0%
0% Other Diabetic Supplies
Outpatient Services/Surgery
$250
30%
Skilled Nursing Facility
$0 copay (days 1-10); $40/day copay (days 11-20); $125 copay (days 21-100)
30%
Gap Coverage
You'll pay $0 / $5 for drugs in Tier 1 and $6/$11 for drugs in Tier 2. Otherwise, you'll pay 45% of the cost of Brand Name drugs and 65% of the cost of Generic drugs on Tiers 3, 4 and 5.
SilverSneakers® Fitness Program
$0
$0
Travel Out of Service Area
Covered
Covered
Prescription Copays and Coinsurances
Preferred Pharmacy
Standard
Annual Prescription Deductible
$0
$0
Tier 1 - Preferred Generic Drugs
$0
$5
Tier 2 - Standard Generic Drugs
$6
$11
Tier 3 - Preferred Brand Drugs
$39
$44
Tier 4 - Standard Brand Drugs
$85
$95
Tier 5 - Specialty Drugs
33% of the cost
33% of the cost
Annual Notice of Change
Evidence of Coverage
Summary of Benefits

2015 Blue Cross Medicare Advantage Plans
Blue Cross Medicare Advantage Basic (HMO)SM
Monthly Premium
$0
In-Network
Medical Deductible
$0
Doctors Office Visits

$20 Primary Care
$45 Physician Specialist
Maximum Out-of-Pocket
$4,900
Over-the-Counter Items Monthly Purchase Allowance*
$10
Dental
Preventive - Covered
Comprehensive - Not Covered
Diabetic Test Strips
0%
0% Other Diabetic Supplies
Outpatient Services/Surgery
$300
Skilled Nursing Facility
$0 copay (days 1-20); $125 copay (days 21-100)
Gap Coverage
You'll pay $0 / $5 for drugs in Tier 1 and $6/$11 for drugs in Tier 2. Otherwise, you'll pay 45% of the cost of Brand Name drugs and 65% of the cost of Generic drugs on Tiers 3, 4 and 5.
SilverSneakers® Fitness Program
$0
Travel Out of Service Area
Covered
Prescription Copays and Coinsurances
Preferred Pharmacy
Standard
Annual Prescription Deductible
$0
$0
Tier 1 - Preferred Generic Drugs
$0
$5
Tier 2 - Standard Generic Drugs
$6
$11
Tier 3 - Preferred Brand Drugs
$39
$44
Tier 4 - Standard Brand Drugs
$85
$95
Tier 5 - Specialty Drugs
33% of the cost
33% of the cost
Annual Notice of Change
Evidence of Coverage
Summary of Benefits

2015 Blue Cross Medicare Advantage Plans
Blue Cross Medicare Advantage Premier Plus (HMO-POS)SM
Monthly Premium
$41
In-Network
Out-of-Network
Medical Deductible
$0
$0
Doctors Office Visits
$20 Primary Care
$40 Primary Care
$45 Physician Specialist
$65 Physician Specialist
Maximum Out-of-Pocket
$4,900
$6,700
Dental
Preventive - Covered
Comprehensive - Not Covered
Preventive - Covered
Comprehensive - Not Covered
Routine Vision
Covered
Not Covered
Diabetic Test Strips
0%
0% Other Diabetic Supplies
Outpatient Services/Surgery
$300
40%
Skilled Nursing Facility
$0 copay (days 1-20); $125 copay (days 21-100)
40%
Gap Coverage
You'll pay $0 / $5 for drugs in Tier 1 and $6/$11 for drugs in Tier 2. Otherwise, you'll pay 45% of the cost of Brand Name drugs and 65% of the cost of Generic drugs on Tiers 3, 4 and 5.
SilverSneakers® Fitness Program
$0
$0
Travel Out of Service Area
Covered
Covered
Prescription Copays and Coinsurances
Preferred Pharmacy
Standard
Annual Prescription Deductible
$0
$0
Tier 1 - Preferred Generic Drugs
$0
$5
Tier 2 - Standard Generic Drugs
$6
$11
Tier 3 - Preferred Brand Drugs
$39
$44
Tier 4 - Standard Brand Drugs
$85
$95
Tier 5 - Specialty Drugs
33% of the cost
33% of the cost
Evidence of Coverage
Summary of Benefits


Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

*If you are a member of a plan with an OTC benefit, you will receive a card with a prefunded monthly benefit allowance. With this allowance, you may purchase eligible OTC and health-related items (i.e. aspirin, cold & flu relief medications, and adhesive bandages) at any participating pharmacy.

Preferred brand diabetic test strips available for pick-up at all pharmacies.

SilverSneakers® is a registered mark of Healthways, Inc.

Healthways SilverSneakers® Fitness Program is a wellness program owned and operated by Healthways, Inc, an independent company.


Thank you for looking at coverage options for Blue Cross Medicare Advantage
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Call 1-866-267-9988 TTY/TDD 711
for personal help finding a plan.


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To verify your recent enrollment, check the status of a claim or ask questions about your existing coverage, please contact Customer Service at: 1-877-774-8592 TTY/TDD 711

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