BlueCross BlueShield of North Carolina

Compare HMO/PPO Plans

Blue Medicare HMO

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Blue Medicare PPO

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Medical Only Plan Standard Plan Enhanced Plan Enhanced Plan Enhanced Freedom Plan
Additional monthly premium1,2 $0 $0 $18.90 $38 $121.30
Features
  • Includes our most robust medical benefits

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  • Includes basic medical benefits
  • Standard drug coverage included

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  • Includes our most robust medical benefits
  • Enhanced prescription drug coverage included

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  • Freedom to visit out-of-network providers

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  • Freedom to visit out-of-network providers at generally the same benefit level as in-network providers

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Provider Choice
  • In-network benefits only

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  • Must use a network provider

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  • In- and out-of-network benefits
  • Choice of any network physician for less cost
  • Choice of an out-of-network physician for higher cost

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  • Choice of any network or out-of-network physician at generally the same cost

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Primary care physician office visits3
  • $5 copayment for in-network visits only

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  • $10 copayment for in-network visits only

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  • $15 copayment for in-network visits only

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  • $20 copayment for in-network visits

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  • Pay 20% coinsurance for out-of-network visits4

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  • $35 copayment for out-of-network visits

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Inpatient hospital stay per day
  • $100, up to 7 days

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  • $220, up to 7 days

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  • $170, up to 7 days

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Medicare prescription drug benefit
  • Includes our standard drug benefit

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  • Includes our enhanced drug benefit

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  • No deductible

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You pay the following up to $2,850 out-of-pocket
  • Tier 1 Preferred generics
$3 $3 $3 $3
  • Tier 2 Non-preferred generics
$6 $6 $6 $6
  • Tier 3 Preferred brand
$40 $30 $40 $30
  • Tier 4 Non-preferred brand
$80 $70 $80 $70
  • Tier 5 Specialty
33% 33% 33% 33%
  • Tier 1 Preferred generics
$8 $8 $8 $8
  • Tier 2 Non-preferred generics
$25 $20 $25 $20
  • Tier 3 Preferred brand
$45 $45 $45 $45
  • Tier 4 Non-preferred brand
$95 $95 $95 $95
  • Tier 5 Specialty
33% 33% 33% 33%
During the Coverage Gap
  • 72% on all generic drugs

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  • $3 for preferred pharmacies
  • $8 for non-preferred pharmacies
  • 72% on all other generic drugs

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  • A discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550

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Catastrophic Coverage
  • You pay 5%

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  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.

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Blue Medicare HMO

Get Started Remind Me

Blue Medicare PPO

Get Started Remind Me
Additional monthly premium1,2
HMO Medical-only $0
HMO Standard $0
HMO Enhanced $18.90
PPO Enhanced $38
PPO Enhanced Freedom $121.30
Features
HMO Medical-only
  • Includes our most robust medical benefits
HMO Standard
  • Includes basic medical benefits
  • Standard drug coverage included
HMO Enhanced
  • Includes our most robust medical benefits
  • Enhanced prescription drug coverage included
PPO Enhanced
  • Freedom to visit out-of-network providers
PPO Enhanced Freedom
  • Freedom to visit out-of-network providers at generally the same benefit level as in-network providers
Provider Choice
HMO Medical-only
  • In-network benefits only
  • Must use a network provider
HMO Standard
  • In-network benefits only
  • Must use a network provider
HMO Enhanced
  • In-network benefits only
  • Must use a network provider
PPO Enhanced
  • In- and out-of-network benefits
  • Choice of any network physician for less cost
  • Choice of an out-of-network physician for higher cost
PPO Enhanced Freedom
  • Choice of any network or out-of-network physician at generally the same cost
Primary care physician office visits3
HMO Medical-only
  • $5 copayment for in-network visits only
HMO Standard
  • $15 copayment for in-network visits only
HMO Enhanced
  • $10 copayment for in-network visits only
PPO Enhanced
  • $20 copayment for in-network visits
  • Pay 20% coinsurance for out-of-network visits4
PPO Enhanced Freedom
  • $15 copayment for in-network visits only
  • $35 copayment for out-of-network visits
Inpatient hospital stay per day
HMO Medical-only
  • $100, up to 7 days
HMO Standard
  • $220, up to 7 days
HMO Enhanced
  • $170, up to 7 days
PPO Enhanced
  • $220, up to 7 days
PPO Enhanced Freedom
  • $170, up to 7 days
Medicare prescription drug benefit
HMO Medical-only
HMO Standard
  • Includes our standard drug benefit
  • No deductible
HMO Enhanced
  • Includes our enhanced drug benefit
  • No deductible
PPO Enhanced
  • Includes our standard drug benefit
  • No deductible
PPO Enhanced Freedom
  • Includes our enhanced drug benefit
  • No deductible
You pay the following up to $2,850 out-of-pocket
HMO Medical-only
HMO Standard Tier 1 Preferred generics $3
Tier 2 Non-preferred generics $6
Tier 3 Preferred brand $40
Tier 4 Non-preferred brand $80
Tier 5 Specialty 33%
HMO Enhanced Tier 1 Preferred generics $3
Tier 2 Non-preferred generics $6
Tier 3 Preferred brand $30
Tier 4 Non-preferred brand $70
Tier 5 Specialty 33%
PPO Enhanced Tier 1 Preferred generics $3
Tier 2 Non-preferred generics $6
Tier 3 Preferred brand $40
Tier 4 Non-preferred brand $80
Tier 5 Specialty 33%
PPO Enhanced Freedom Tier 1 Preferred generics $3
Tier 2 Non-preferred generics $6
Tier 3 Preferred brand $30
Tier 4 Non-preferred brand $70
Tier 5 Specialty 33%
HMO Medical-only
HMO Standard Tier 1 Preferred generics $8
Tier 2 Non-preferred generics $25
Tier 3 Preferred brand $45
Tier 4 Non-preferred brand $95
Tier 5 Specialty 33%
HMO Enhanced Tier 1 Preferred generics $8
Tier 2 Non-preferred generics $20
Tier 3 Preferred brand $45
Tier 4 Non-preferred brand $95
Tier 5 Specialty 33%
PPO Enhanced Tier 1 Preferred generics $8
Tier 2 Non-preferred generics $25
Tier 3 Preferred brand $45
Tier 4 Non-preferred brand $95
Tier 5 Specialty 33%
PPO Enhanced Freedom Tier 1 Preferred generics $8
Tier 2 Non-preferred generics $20
Tier 3 Preferred brand $45
Tier 4 Non-preferred brand $95
Tier 5 Specialty 33%
During the Coverage Gap
HMO Medical-only
HMO Standard
  • 72% on all generic drugs
  • A discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
HMO Enhanced
  • $3 for preferred pharmacies
  • $8 for non-preferred pharmacies
  • 72% on all other generic drugs
  • A discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
PPO Enhanced
  • 72% on all generic drugs
  • A discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
PPO Enhanced Freedom
  • $3 for preferred pharmacies
  • $8 for non-preferred pharmacies
  • 72% on all other generic drugs
  • A discount on brand name drugs until your yearly out-of-pocket drug costs reach $4,550
Catastrophic Coverage
HMO Medical-only
HMO Standard
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.
HMO Enhanced
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.
PPO Enhanced
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.
PPO Enhanced Freedom
  • You pay 5%
  • After you reach $4,550 in out-of-pocket costs, the plan pays the majority of the drug costs until the end of the year. You pay the greater of $2.55 for generic, $6.35 for brand name or 5% of the total drug cost.

Blue Medicare HMO

Get Started Remind Me

Blue Medicare PPO

Get Started Remind Me
  1. As a member of one of the Blue Medicare HMO or Blue Medicare PPO, you must continue to pay the Medicare Part B premium in addition to your plan premium. Note that limitations, copayments and restrictions may apply.
  2. If you decide to switch to premium withhold or move from premium withhold to direct bill, it could take up to three months for the change to take effect, and you will be responsible for premiums during that time.
  3. You must receive all routine care from plan providers.
  4. Except for emergency or urgent care, you may pay more for out-of-network provider services.

Important Legal Information and Disclaimers

U9475, 10/14

The information on this page is current as of 10/01/2014.

Y0079_6741 CMS Approved 10022014