NextBlue Premium PPO (PPO) – H6202-002-0
Coverage, cost, and availability details for NextBlue of North Dakota’s H6202-002-0 Medicare Advantage plan are presented here for 2025.
Health Plan Costs
💰 Monthly Premium, Deductible, Max Out-of-Pocket & Giveback
Monthly Premium: The total monthly premium is $73.00, including drug coverage. You must also pay your standard Medicare Part B premium.
Health Plan Deductible: Some health plans have a deductible (amount you pay before cost-sharing begins). This plan's deductible is $0.00.
Maximum Out-of-Pocket: All Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. This is the most you will pay for standard health services in a year before that plan begins paying all costs. This plan's MOOP is $4,500.00 for in-network services, excluding the cost of your Part D medications.
Part B Giveback: This plan offers a Part B premium giveback of $0.00.
Health Plan Out-of-Pocket Costs
🩺 Doctor’s Office Visits
- Primary: $0 Copay
- Specialist: $30 Copay
- NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
🏥 Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care: $110 Copay
- Urgent care: $40 Copay
- Ground ambulance: $150 Copay
- Inpatient hospital care: $400.00 per stay
- Skilled Nursing Facility: $0.00 per day for days 1 through 20
$150.00 per day for days 21 through 48
$0.00 per day for days 49 and beyond
🦶 Foot Care
- Foot Exams and Treatments (Medicare-covered): $40 Copay
- Routine Foot Care: Not Covered
💆 Chiropractic Care
- Medicare-covered chiropractic: $20 Copay
- Routine chiropractic: Not Covered
🧠 Mental Health Services
- Outpatient individual therapy: $30 Copay
- Outpatient group therapy: $30 Copay
- Inpatient psychiatric hospital care: $400.00 per stay
🏋️ Rehabilitation Services
- Physical therapy and speech and language therapy: $30 Copay
- Occupational therapy: $30 Copay
🧰 Medical Equipment and Supplies
- Diabetes supplies: 0% Coinsurance
- Durable medical equipment: 20% Coinsurance
Prior Authorization Required - Prosthetics: 20% Coinsurance
🔬 Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services: $325 Copay
Prior Authorization Required - Lab services: $0 Copay
Prior Authorization Required - Outpatient x-rays: $15 Copay
Prior Authorization Required - Diagnostic tests and procedures: $150 Copay
Prior Authorization Required
💉 Medicare Part B Drugs
- Chemotherapy: 20% Coinsurance
- Other Part B drugs (Medicare-covered): 20% Coinsurance
Supplemental Benefits
🦷 Dental Services
- Medicare Covered Preventive Dental: $30 Copay
- Oral exam: $0
- Dental x-rays: $0
- Cleaning: $0
- Periodontics: Not Covered
- Endodontics: Not Covered
- Restorative Services: Not Covered
👂 Hearing Aids and Services
- Fitting/evaluation: Covered
Limits may apply - Hearing aids: Not Covered
- Hearing exam: Covered
Limits may apply
👓 Vision Services
- Medicare-covered eye exam: $ to $30 Copay
- Routine eye exam: Covered
Limits may apply - Eyewear benefits: None
Prescription Drug Costs & Benefits
NextBlue Premium PPO includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Costs & Benefits
📦 This plan’s prescription drug deductible is $240.00.
You’ll need to pay this amount before NextBlue of North Dakota begins helping with drug costs.
📊 See what you’ll pay for covered prescriptions by tier and pharmacy type.
| Drug Tier | Retail Pharmacy | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic* | $6.00 | $6.00 |
| Preferred Brand | $47.00 | $47.00 |
| Non-Preferred Drug | $100.00 | $100.00 |
| Specialty Tier | 30.00% | 30.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| * Not all tiers apply to the deductible. See the formulary for full details. | ||
Drug tiers group medications by type and cost. Tier 1 has the lowest-cost generics, and Tier 5 includes specialty drugs.
View the plan’s complete formulary drug list (opens in a new browser tab).
💡 Learn how Extra Help could lower your drug costs.
If you qualify for the Social Security Extra Help program, your Part D premium may be reduced.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Amount Paid by CMS: | $12.50 |
| Your Adjusted Premium: | $0.00 |
Learn more at the Social Security Extra Help program .
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (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 CMS ratings for NextBlue Premium PPO.
Plan Availability
NextBlue Premium PPO (H6202-002-0) is available in the following locations (click to open):
Need Help Enrolling?
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent and learn more about this plan and others on this site.
Or enroll online through our trusted and secure platform:
🚀 Enroll Online NowClicking this button will open MedicareEnrollment.com (powered by HealthCompare Insurance Services) and the official NextBlue of North Dakota plan page.
📄 View NextBlue of North Dakota Contact Information
| Website: | NextBlue of North Dakota Plan Page (opens in new tab) |
|---|---|
| Providers: | NextBlue of North Dakota Providers Page (opens in new tab) |
| Formulary: | NextBlue of North Dakota Formulary Page (opens in new tab) |
| Pharmacy: | NextBlue of North Dakota Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (844)753-5678 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (844)753-5678 |
| New Member Part D TTY Users: | 711 |
🔍 Why This Information Matters
Many Medicare websites only show you their own phone numbers and redirect you to their sales team. We believe you deserve full access to your plan resources — including direct links to the official NextBlue of North Dakota site, provider directories, and support contacts.
That’s why we include this information here, clearly and transparently — so you can research and enroll with confidence.
🛡️ Official Medicare Enrollment Resources
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.
Frequently Asked Questions
📘 What does Medicare plan code H6202 002 mean?
NextBlue Premium PPO is a Medicare Advantage plan by NextBlue of North Dakota. The code H6202 is the CMS contract ID, whereas 002 is its plan ID.
- Plan Name: NextBlue Premium PPO
- Plan Type: PPO
- Premium: $73.00/mo + your monthly Part B premium
- Out-of-Pocket Max: $4,500.00 (in-network)
- Drug Coverage: Includes Medicare Part D prescription drug coverage with tiered cost sharing.
- CMS Star Rating: 4 out of 5
- Contract Year: 2025
This information is based on official CMS data and is provided for educational purposes. Always review your plan’s official documents or contact the provider directly before making enrollment decisions.
📋 What type of plan is H6202 002?
This plan is a PPO — specifically, it's an PPO plan with a Medicare Advantage contract that's offered by NextBlue of North Dakota. It comes with defined provider network rules you should be aware of.
- Plan Marketing Name: NextBlue Premium PPO
- Network Type: Preferred Provider Organization with in- and out-of-network coverage.
- Referral Requirement: Referrals are generally not required, though some services may be exceptions. Refer to the plan’s coverage tables above.
- Prescription Coverage: Includes Medicare Part D prescription drug coverage with tiered cost sharing.
Plan types like HMOs and PPOs determine whether you can go out-of-network or need referrals to see specialists.
📦 What benefits are included in H6202 002?
This plan covers all Medicare Part A and Part B services. Depending on the plan, it may also include valuable extras like dental, vision, and hearing benefits.
- Medical Services: Hospital, doctor visits, preventive care
- Prescription Drugs: Enhanced, $240.00 deductible
- Dental: No — this plan does not include dental benefits.
- Vision: Yes — vision benefits are included. Review the vision section above for copay and limit details.
- Hearing: Yes — hearing benefits are included. See the coverage details above to learn what services are covered.
Benefit availability may vary by location and plan version. Confirm specific details in your plan's Evidence of Coverage (EOC).