Blue Cross Medicare Advantage Flex (PPO) Plan Details for Valencia County, NM
CMS rated this Blue Cross and Blue Shield of IL, NM plan 3.0 (Average) out of 5 stars.
Blue Cross Medicare Advantage Flex (PPO) is a Medicare Advantage plan with a prescription drug plan. 2025 plan enrollment starts Oct. 15.
See more Medicare Advantage Plans in Valencia County, New Mexico.
2025 Blue Cross Medicare Advantage Flex Cost and Coverage Notification
The 2025 cost and coverage information for Blue Cross Medicare Advantage Flex will not be available until early October. We'll notify you as soon as it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 Annual Enrollment Period begins October 15.
Blue Cross Medicare Advantage Flex Basic Details
Plan Basics | |
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Plan ID: | H8634-015-0 |
Plan Type: | Local PPO |
Plan Year: | 2024 |
Premium: | $197.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $0/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced, $545.00 deductible |
Rx Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | Valencia County, NM |
Insured By: | Blue Cross and Blue Shield of IL, NM |
Summary of Benefits |
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Blue Cross and Blue Shield of IL, NM Out-of-Pocket Costs
This Blue Cross and Blue Shield of IL, NM 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 H8634-015-0.
NOTE: Most 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: | 0% Coinsurance |
Specialist: | 0% Coinsurance Prior Authorization Required |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | 0% Coinsurance Prior Authorization Required |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | 0% Coinsurance Prior Authorization Required |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | 0% Coinsurance |
Urgent care: | 0% Coinsurance |
Ground ambulance: | 0% Coinsurance |
Inpatient hospital coverage: | |
Outpatient hospital coverage: | 0% Coinsurance Prior Authorization Required |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | 0% Coinsurance |
Outpatient group therapy visit with a psychiatrist: | 0% Coinsurance |
Inpatient hospital - psychiatric: | |
Outpatient group therapy visit: | 0% Coinsurance |
Outpatient individual therapy visit: | 0% Coinsurance Prior Authorization Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | 0% Coinsurance Prior Authorization Required |
Occupational therapy visit: | 0% Coinsurance Prior Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | 0% Coinsurance Prior Authorization Required |
Durable medical equipment (e.g., wheelchairs, oxygen): | 0% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 0% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | 0% Coinsurance Prior Authorization Required |
Lab services: | 0% Coinsurance Prior Authorization Required |
Outpatient x-rays: | 0% Coinsurance Prior Authorization Required |
Diagnostic tests and procedures: | 0% Coinsurance Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 0% Coinsurance |
Other Part B drugs (Medicare-covered) | 0% Coinsurance |
Feel free to download our Blue Cross Medicare Advantage Flex Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Blue Cross and Blue Shield of IL, NM 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) | 0% Coinsurance Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | 0% Coinsurance |
Vision | Maximum vision benefit: | Non Specified |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | 0% Coinsurance |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Blue Cross Medicare Advantage Flex includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
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: | $4.40 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $4.40 |
Part D Premium with Full LIS Assistance: | $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 $545.00. You must pay this amount at the pharmacy before Blue Cross and Blue Shield of IL, NM begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Blue Cross Medicare Advantage Flex has out-of-pocket costs you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | $0.00 copay (deductible does not apply) | $15.00 copay (deductible does not apply) |
2 (Generic) | $8.00 copay | $20.00 copay |
3 (Preferred Brand) | $47.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay |
5 (Specialty Tier) | 25% | 25% |
CMS 5-Star Rating Marks
The following table shows the quality ratings for this Blue Cross and Blue Shield of IL, NM plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories using a 5-star rating system. Here are the most recent ratings for Blue Cross Medicare Advantage Flex.
CMS Measure | Star Rating |
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2024 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 | |
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:
- Blue Cross Medicare Advantage Classic
- Blue Cross Medicare Advantage Flex
- Blue Cross Medicare Advantage Classic
- Blue Cross Medicare Advantage Essential
- Blue Cross Medicare Advantage Protect
- Blue Cross Medicare Advantage Choice Premier
- Blue Cross Medicare Advantage Health Choice
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 IL, NM
Plan Website: | http://getblueil.com/mapd |
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Formulary Information: | http://getblueil.com/mapd/pharmacies |
Pharmacy Information: | Blue Cross and Blue Shield of IL, NM Pharmacy Page |
Prospective Members: | (877)583-8129 |
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 IL, NM, http://getblueil.com/mapd, Last Accessed February 20, 2024
- Medicare.gov, "Medicare Advantage Plans cover all Medicare services", Last Accessed February 20, 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, "What Medicare Covers", Last Accessed February 7, 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 Blue Shield, 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.