Platinum Blue Core Plan with Rx (COST) Plan Details for McLeod County, MN
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*CMS rated this Blue Cross and Blue Shield of Minnesota plan (H2461-008-0) 4.5 (Good+) out of 5 stars.
Platinum Blue Core Plan with Rx (Cost) is a Medicare Advantage plan with a prescription drug plan. The 2025 Annual Enrollment period starts October 15. Plan benefits begin January
See more Medicare Advantage Plans in McLeod County, Minnesota.
Platinum Blue Core Plan with Rx Basic Details
Plan Basics | |
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Plan ID: | H2461-008-0 |
Plan Type: | Cost |
Plan Year: | 2025 |
Premium: | $60.40/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | 6,000.00 /yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Basic, $590.00 deductible |
Supplemental Benefits: | Hearing |
Availability: | McLeod County, MN |
Insured By: | Blue Cross and Blue Shield of Minnesota |
Summary of Benefits |
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Blue Cross and Blue Shield of Minnesota Out-of-Pocket Costs
This Blue Cross and Blue Shield of Minnesota Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H2461-008-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $20 Copay |
Specialist: | 20% Coinsurance Prior Authorization Required |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $50 Copay |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay Prior Authorization Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $125 Copay |
Urgent care: | $55 Copay |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital coverage: | $600.00 per stay |
Outpatient hospital coverage: | $0 |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $20 Copay |
Outpatient group therapy visit with a psychiatrist: | $20 Copay |
Inpatient hospital - psychiatric: | $600.00 per stay |
Outpatient group therapy visit: | $20 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $40 Copay |
Occupational therapy visit: | $40 Copay |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment (e.g., wheelchairs, oxygen): | 40% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 20% Coinsurance |
Lab services: | $0 |
Outpatient x-rays: | $60 Copay |
Diagnostic tests and procedures: | $25 Copay |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our Platinum Blue Core Plan with Rx Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Blue Cross and Blue Shield of Minnesota includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Not Covered |
Contact lenses (In-Network) | Not Covered |
Prescription Drug Plan Costs & Benefits
Platinum Blue Core Plan with Rx includes a basic benefit Medicare Part D plan (PDP). Basic plans meet the minimum coverage standards set by the Centers for Medicare & Medicaid Services (CMS). These plans may have higher cost-sharing, deductibles, or limited drug coverage compared to enhanced plans, but they still provide essential prescription drug coverage at a lower premium.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the premium details of this prescription drug plan.
Basic Part D Premium: | $23.40 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $23.40 |
Low Income Premium Subsidy: | $50.63 |
Low Income Premium Subsidy CMS Pays: | $23.40 |
Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Blue Cross and Blue Shield of Minnesota begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Platinum Blue Core Plan with Rx has out-of-pocket costs you must pay when you pick up your prescriptions.
Drug Tier | Retail | Mail Order | Out of Network |
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Preferred Generic | $0.00 | $5.00 | $0.00 |
Generic | $5.00 | $10.00 | $5.00 |
Preferred Brand | 25.00% | 25.00% | 25.00% |
Non-Preferred Drug | 44.00% | 46.00% | 44.00% |
Specialty Tier | 25.00% | 25.00% | 25.00% |
*The Part D deductible does not apply. |
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join Platinum Blue Core Plan with Rx .
CMS Measure | Star Rating |
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2025 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | Not enough data available |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- Platinum Blue Choice Plan with Rx
- Platinum Blue Choice Plan
- Platinum Blue Core Plan with Rx
- Platinum Blue Core Plan
- Platinum Blue Complete Plan
- Platinum Blue Complete Plan with Rx
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Blue Cross and Blue Shield of Minnesota
Plan Website: | http://www.bluecrossmn.com/medicare |
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Formulary Information: | http://www.myprime.com |
Pharmacy Information: | Blue Cross and Blue Shield of Minnesota Pharmacy Page |
Prospective Members: | (866)340-8654 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Blue Cross and Blue Shield of Minnesota, http://www.bluecrossmn.com/medicare, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed June 3, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.