With Blue Advantage, you don’t need to buy a separate Medicare supplement or Part D prescription drug plan.

Even better, the plan comes with the valuable extra benefits such as dental, vision, hearing and fitness coverage that helps save you even more. And with the Silver & Fit® Program, you can get a no-cost fitness facility membership with access to a broad network of participating fitness facilities nationwide or the Home Fitness option, plus rewards, challenges and much more.

Covered Benefit

Member Share

Plan Year Deductible


Out-of-Pocket-Maximum (In-Network)


Out-of-Pocket Maximum (Out-of-Network)


Co-pay – Primary Care/Specialist

$5/$20 per visit (In network)

Emergency Room

$50 co-pay per visit

Inpatient Hospital

$50/day (days 1-10 in network)

Prescription Drugs (Part D)

  •  Tier 1
  •  Tier 2
  •  Tier 3
  •  Tier 4
  •  Tier 5
  •  $5
  •  $10
  •  $25
  •  $50
  •  20%
You may view the formulary at

Additional Benefits

Preventative Dental

$0 copay for preventative visits.


$130 allowance for one pair of frames or contact lenses per year

Over-the-Counter (OTC) Allowance

50 credits per quarter OTC benefits (includes over-the-counter drugs, incontinence supplies and other medical and first aid supplies)

Online Primary Care Provider Visits

$0 copay for online primary care provider visits (available on a computer, tablet and smartphone 24 hours a day, 7 days a week)

Post Discharge Meals

2 meals per day, up to 5 days (after discharge from acute-care inpatient stay)

Member Wellness Rewards

Up to $50 per year in gift cards for completing approved wellness exams and/or screenings



Blue Advantage HMO

Member Wellness Portal


8:00 AM – 8:00 PM

Seven days a week

Provider Directories

Summary of Benefits

Benefit Comparison

Premium Rates