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Medicare Advantage
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Pennsylvania
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Berks County
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BlueJourney Premier

BlueJourney Premier Berks County, PA — 2021 Medicare Advantage Plan

This page provides HMO health plan information about BlueJourney Premier, a 2021 Medicare Advantage plan available to beneficiaries in Berks County, Pennsylvania. If you join this plan you agree to allow Capital BlueCross to provide your Medicare health benefits.
If you need assistance, call us at 1-855-266-4865
Capital BlueCross logo

This page contains editorial content that is not endorsed or approved by Capital BlueCross[2]. This is not a solicitation of insurance.

Contact the Plan
Medicare Rating:
☆☆☆☆☆
CMS Plan ID:H3962-001
CMS Plan Year:2021
Premium:$106.00/mo
Premium Valid:Until 2021-12-31
Drug Plan:Yes
Rx Deductible:$0.00/year
Online Pharmacy:No
Rx Gap Coverage:Yes
Availability:Berks County, PA
Policy Valid:2021-1-1 to 2021-12-31
Insured By:Capital BlueCross

BlueJourney Premier
2021 Copays in Berks County, PA

Healthcare ServiceMember Cost
Primary Care Doctor:$5 co-pay
Mental Health Specialist (individual):$25 co-pay
Mental Health Specialist (group):$25 co-pay
Chiropractic Services as a supplemental benefit:None
Occupational Therapy Specialist:$20 co-pay
Podiatrist Services (Medicare Covered):None
Telehealth Services:20% co-insurance
Telehealth Services:$0-25 co-pay
Emergency Room Care:$120 co-pay
(waived if admitted within 24 days)
Urgent Care:$30 co-pay
Ambulance Services:$100 co-pay
Hospital Inpatient Stay:$80 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Outpatient Lab Services:$10 co-pay
Outpatient Diag Services:$5 co-pay
Routine Eye Exams:Covered
(limited coverage, no additional premium)
Eye Glasses:Upgrades: Yes
Contact lenses: No
Eyeglasses (lenses & frames): Yes
Eyeglass lenses: Yes
Eyeglass frames: No
Limits Apply
Optional coverage
Hearing Exams:Routine Exams: Yes
(limits and co-pay/insurance apply)
Aid Eval/Fitting: Yes
(limits and co-pay/insurance apply)
Hearing Aids:Over the ear: Yes
Outer ear: No
Inner ear: No
(limits and co-pay/insurance apply)

BlueJourney Premier
Prescription Copays in Berks County, PA

TierPreferredStandard
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%
In addition to the monthly premium and Part D deductible, BlueJourney Premier has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. The table above shows you those costs.

BlueJourney Premier
CMS 5-Star Review Ratings

CMS MeasureStar Rating
2021 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☆☆☆☆☆
People commonly ask, "Is BlueJourney Premier any good?" In this table we show you the quality ratings. 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.

BlueJourney Premier 2021 Medicare Advantage HMO Plan for Berks County, PA

BlueJourney Premier is a Medicare Advantage plan, from Capital BlueCross, that's available to beneficiaries living in Berks County, Pennsylvania.

  1. It's a Health Maintenance Organization (HMO) health plan.
  2. It includes a prescription drug plan.
  3. It has the same health insurance benefits as Original Medicare.
  4. It offers extras that Original Medicare does not cover.
  5. The maximum out-of-pocket cost with this plan is $3,400 .
  6. The monthly premium is $106.00 (plus your Part B premium).

BlueJourney Premier vs. Original Medicare in Berks County, PA

This HMO plan replaces your Part A and Part B Medicare coverage with a managed care health plan in Berks County, Pennsylvania. If you enroll in BlueJourney Premier you agree to let Capital BlueCross manage your Medicare benefits, including:

  1. Medicare Part A (hospital insurance).
  2. Medicare Part B (medical insurance).
  3. Medicare Part D (prescription drug coverage).
  4. Additional benefits included in the plan not covered by Medicare.
  5. Emergency medical coverage when you travel outside of your county (USA and it's territories only).

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.

Monthly Premium

BlueJourney Premier's monthly premium in Berks County is $106.00. That includes your prescription coverage, 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).

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 BlueJourney Premier, 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.

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.

Contact Capital BlueCross

For more information about this plan, and other plans on this site, call 1-855-266-4865. You may also contact the plan:

Prospective Members:(800)990-4201
TTY Users:(711)-
Plan Website:http://www.capitalbluemedicare.com
Formulay Information:Capital BlueCross Formulary Page
Pharmacy Information:Capital BlueCross Pharmacy Page

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. To learn more about this plan, visit the Capital BlueCross Medicare website.

Compare Plan Options

The average Pennsylvania senior compares three or more plan options before making an enrollment decision.

Additional Medicare 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:

  • AmeriHealth Caritas VIP Care (Local HMO), for Dual-Eligible beneficiaries
  • Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
  • UPMC for Life Complete Care (Local HMO), for Dual-Eligible beneficiaries
  • UnitedHealthcare Dual Complete (Local HMO), for Dual-Eligible beneficiaries
  • Health Partners Medicare Special (Local HMO), for Dual-Eligible beneficiaries

Not qualified for an SNP? Here are some additional plans you might consider:

  • Allwell Medicare Simple (HMO)
  • Cigna True Choice Plus Medicare (PPO)
  • Aetna Medicare Value (PPO)
  • BlueJourney Classic (PPO)
  • AARP Medicare Advantage Choice Plan 3 (PPO)

RELATED: Top 9 Advantages and Disadvantages of Medicare Advantage Plans

The Medicare Part C information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on October 15, 2020.

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