BlueJourney Premier 2020 Medicare Advantage Plan for Berks County, PA
On this page we help consumers: Compare BlueJourney Premier with all 2020 Medicare Advantage Plans available in Berks County, Pennsylvania. This is a HMO plan with a $148.00/mo premium and $3,400 max out-of-pocket limit.
| Medicare Rating: |  |
|---|---|
| CMS Plan ID: | H3962-001 |
| CMS Plan Year: | 2020 |
| Premium: | $148.00/mo |
| Premium Valid: | Until 2020-12-31 |
| Drug Plan: | Yes |
| Rx Deductible: | $0.00/year |
| Online Pharmacy: | No |
| Rx Gap Coverage: | Yes |
| Availability: | Berks County, PA |
| Policy Valid: | 2020-1-1 to 2020-12-31 |
| Insured By: | Capital BlueCross |
BlueJourney Premier 2020 Medicare Advantage HMO Plan for Berks County, PA
BlueJourney Premier is a Medicare Advantage plan, from Capital BlueCross, that's available to Medicare beneficiaries living in Berks County, Pennsylvania.
- It's a Health Maintenance Organization (HMO) health plan.
- It includes a prescription drug plan.
- It has the same health insurance benefits as Original Medicare.
- It offers extras that Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $3,400 .
- The monthly premium is $148.00 (plus your Part B premium).
BlueJourney Premier vs. Traditional Medicare in Berks County
This HMO plan replaces your Medicare coverage with managed care in Berks County. If you enroll in BlueJourney Premier you agree to let Capital BlueCross manage your Medicare benefits, including:
- Medicare Part A (hospital insurance).
- Medicare Part B (medical insurance).
- Medicare Part D (prescription drug coverage).
- Additional benefits included in the plan not covered by Medicare.
The benefit of an HMO plan, like BlueJourney Premier, is predictable out-of-pocket expenses. Although more restrictive than Original Medicare, HMOs limit your annual out-of-pocket costs. With traditional Medicare there's no cap, leaving you vulnerable to excessive medical bills.
BlueJourney Premier Review
These are the areas of the plan that are important to compare and review:
- Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
- Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
- CMS Ratings: Important measurements across 9 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Medications are expensive, so you'll want to know how this plan covers your prescriptions.
- Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.
IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.
CRITICAL: BlueJourney Premier includes a Medicare Drug Plan which has its own deductible and co-pays. If you have regular prescriptions, make sure they are covered at a favorable price before you join this plan. Prescription drug plans vary significantly by plan. Make sure you have the best coverage.
How Much Does BlueJourney Premier Cost?
The premium on this plan is $148.00 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H3962-001 Summary of Benefits below).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $0.00 per year. That means you have first dollar coverage.
IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
What is the Maximum Out-of-Pocket (MOOP) Limit?
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The BlueJourney Premier plan MOOP is $3,400 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in Berks County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
Medicare 5-Star Ratings
In this section we show you the quality rating for this Capital BlueCross plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this health plan.
| CMS Measure | Star Rating |
|---|---|
| 2020 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 | |
Does BlueJourney Premier include Medicare Part D?
This plan includes prescription drug coverage (Medicare Part D). If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.
In addition to the monthly premium and Part D deductible, the drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the drug coverage schedule for this plan:
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $3.00 copay | $8.00 copay |
| 2 (Generic) | $10.00 copay | $15.00 copay |
| 3 (Preferred Brand) | $42.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
| 5 (Specialty Tier) | 33% | 33% |
How Much are the Copays & Co-Insurance?
In this Summary of Benefits section we outline high-level information about the plan's co-payment and co-insurance costs for inpatient, outpatient, preventive care, transportation and other healthcare services. For complete details or assistance call: 1-855-266-4865.
BlueJourney Premier vs. Medigap
To compare BlueJourney Premier with a Medigap plan (Medicare supplemental insurance), you need to evaluate your healthcare and financial needs. Look at the total potential cost with each plan type, not just the monthly premium, and choose how you want to use medical care (locally or nationally).
To help you make a better decision, we created our How-to Choose the Best Medicare Plan guide. It will help you understand how to compare BlueJourney Premier with Medicare Supplement plans in Pennsylvania. Medicare Plan F in Pennsylvania is the most popular.
Contact Capital BlueCross
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare 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 Advantage program on www.medicare.gov or the Wikipedia page. To learn more about this plan, visit the Capital BlueCross Medicare website.
Additional Plan Options in Berks County
Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
- UnitedHealthcare Dual Complete (Local HMO), for Dual-Eligible beneficiaries
- Geisinger Gold Secure Rx (Local HMO), for Dual-Eligible beneficiaries
- Aetna Medicare Advantra Cares (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Lasso Healthcare (MSA)
- AARP Medicare Advantage (HMO)
- AARP Medicare Advantage Choice Plan 1 (PPO)
- AARP Medicare Advantage Choice Plan 2 (PPO)
- AARP Medicare Advantage Choice Plan 3 (PPO)
Medicare Part C Plan Availability
BlueJourney Premier is available to beneficiaries living in Hereford, Bally, Barto, Bechtelsville, Bernville, Bethel, Birdsboro, Blandon, Bowers, Boyertown, Centerport, Douglassville, Earlville, Fleetwood, Geigertown, Hamburg, Kempton, Kutztown, Leesport, Lenhartsville, Limekiln, Lyon Station, Maxatawny, Mertztown, Mohnton, Mohrsville, Monocacy Station, Morgantown, Mount Aetna, New Berlinville, Oley, Pine Forge, Rehrersburg, Robesonia, Shartlesville, Shoemakersville, Strausstown, Temple, Topton, Virginville, Wernersville, Womelsdorf, Reading, and all other areas of Berks County, Pennsylvania; Medicare plans are the same throughout the County.
The Medicare Part C information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on .