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2027 HMO and PPO Plan Options

With Medicare Advantage plans from Blue Cross and Blue Shield of Nebraska you'll have predictable, easy-to-budget costs for doctor office visits, prescription drugs and more. Each plan offers a different level of benefits and out-of-pocket cost, so you can choose the one that is best suited to your needs.

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Hospital and Medical Benefits

Click for more details Medicare Advantage
Assure HMO		 Medicare Advantage
Connect PPO		 Medicare Advantage
Protect PPO
  When in- and out-of-network costs are applicable, costs are listed as follows:
(In-Network/Out-of-Network)
Monthly Premium
n/a
$0 $0 $48
Medical Deductible
n/a
No deductible No deductible No deductible
Travel Coverage  
Travel coverage means if you travel outside of the state you will be covered similar to in-state in-network benefits.
No Yes Yes
Maximum Out-of-pocket Limit (In-network/Combined in- and out-of-network)  
Maximum out of pocket means the total amount you are responsible to pay for Medicare-covered services.
$5,900 annually In-Network: $6,650 annually
Out-of-Network: $9,000 		In-Network: $5,700 annually
Out-of-Network: $8,000
Primary Care Doctor Visits*  
This is your personally selected Physician to help guide your care.
$0 copay $0 copay $0 copay
Acute Inpatient Hospital Days 1-5: $525 copay
per day
Days 6+: 0$ copay		 Days 1-5: $550 copay
per day
Days 6+: $0 copay		 Days 1-5: $500 copay
per day
Days 6+: $0 copay
Outpatient Hospital Services $525 copay $550 copay $500 copay
Urgent Care $40 copay $50 copay $40 copay
Emergency Care $130 copay $130 copay $130 copay
Inpatient Skilled Nursing Facility  
These facilites have the staff and equipment to give skilled nursing care or rehab services, they could be part of a hospital or nursing home.
Days 1-10: $0 copay
Days 11-20: $10 copay
Days: 21-100: $218 copay		 Days 1-10: $0 copay
Days 11-20: $10 copay
per day
Days 21-100: $218 copay
per day 		Days 1-10: $0 copay
Days 11-20: $10 copay
per day
Days 21-100: $218 copay
per day
Routine Eye Exam (one per year)  
Exam to diagnose diseases and conditions of the eye.
$0 copay $0 copay $0 copay
Routine Hearing Exam (one per year) from TruHearing provider  
Exam to diagnose hearing and balance problems.
$0 copay $0 copay $0 copay
Over-the-Counter (OTC) Benefit $20 quarterly allowance; allowance balance does not roll over to next quarter No quarterly allowance $45 quarterly allowance; allowance balance does not roll over to next quarter
Dental Maximum Reimbursement $500 annual maximum reimbursement for covered services $250 annual maximum reimbursement benefit for covered services $600 annual maximum reimbursement benefit for covered services
Fitness Allowance $300 annual allowance $200 annual allowance $300 annual allowance
Meal Benefit  
Specialized meal program designed for seniors.
2 meals/day for 14 days post hospital discharge 2 meals/day for 14 days post hospital discharge 2 meals/day for 14 days post hospital discharge
Service Area

PPO and HMO PLANS AVAILABLE IN: Adams, Antelope, Arthur, Blaine, Buffalo, Cass, Cedar, Chase, Clay, Colfax, Custer, Deuel, Dodge, Douglas, Dundy, Fillmore, Franklin, Frontier, Furnas, Gage, Garden, Garfield, Grant, Greeley, Hall, Hamilton, Harlan, Hayes, Hitchcock, Hooker, Howard, Jefferson, Kearney, Keith, Knox, Lancaster, Lincoln, Logan, Loup, Madison, McPherson, Nance, Nemaha, Nuckolls, Otoe, Perkins, Platte, Polk, Red Willow, Sarpy, Saunders, Seward, Sherman, Thomas, Thurston, Valley, Washington, Wayne, Webster, Wheeler and York counties

 

Prescription Drug Benefits

Medicare Advantage Assure (HMO), Connect (PPO), Protect (PPO)
Drug Tiers Rx Deductible Copayment/Coinsurance
In-network pharmacy 30-day supply: Preferred Mail-order 100-day supply:
Tier 1
(Preferred Generic)		 $0 $0 $0
Tier 2
(Generic) 		$5 $0
Tier 3
(Preferred Brand) 		$400 15% coinsurance 15% coinsurance
Tier 4
(Non-preferred Drug)		 27% coinsurance N/A
Tier 5
(Specialty tier) 		25% coinsurance N/A
Initial coverage limit You pay copays and coinsurance until your total yearly drug costs reach $2,400.
Catastrophic coverage After paying $2,400, you pay a $0 cost-share for all medications.

 

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Individual Plan Information

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Understanding all the coverage options available may feel confusing. Get important details from Blue Cross and Blue Shield of Nebraska about Medicare options and important dates to remember.

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