Florida Blue Urgent Care Copay



If you’re covered by an Affordable Care Act plan, you have a $0 copay. for your first two visits each year. After that, you pay based on your plan’s standard benefit. GuideWell Emergency Doctors’ three locations are open seven days a week, with no appointment necessary. Know Before You Go: Urgent Care vs. Posted on Apr 11th 2018 by Florida Blue. Back to Blog Home. Florida Blue and Florida Blue HMO do not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of their plans, including.

  1. How Much Is Urgent Care Copay With Blue Cross Blue Shield
  2. Florida Blue Urgent Care Locations
  3. Urgent Care Copay Without Insurance
Basic Option
Preventive Care Nothing for covered preventive screenings, immunizations and services
Physician Care

$30 for primary care1
$40 for specialists1

Virtual doctor visits by Teladoc®

$0 for first 2 visits
$15 all additional visits

Urgent Care Center $35 copay
Prescription Drugs Preferred Retail Pharmacy:
Tier 1 (Generics): $10 copay
Tier 2 (Preferred brand): $55 copay2
Tier 3 (Non-preferred brand): 60% of our allowance ($75 minimum)2
Tier 4 (Preferred specialty): $65 copay2
Tier 5 (Non-preferred specialty): $90 copay2
Mail Service Pharmacy:
Available to members with Medicare Part B primary only. Visit the Medicare page for more information.
Tier 1 (Generics): $20
Tier 2 (Preferred brand): $100 copay
Tier 3 (Non-preferred brand): $125 copay
Specialty Pharmacy:
Tier 4 (Preferred specialty): $85 copay2
Tier 5 (Non-preferred specialty): $110 copay2
Maternity Care $175 inpatient
$0 outpatient
Hospital Care

Inpatient (Precertification is required): $175 per day; up to $875 per admission

Outpatient: $100 per day per facility1

Surgery

$150 in an office setting1

$200 in a non-office setting1

ER (accidental injury)

$175 per day per facility

ER (medical emergency)

$175 per day per facility

Lab work (such as blood tests) $0 copay1
Diagnostic services
(such as sleep studies, CT scans)

Up to $100 in an office1

Up to $150 in a hospital1

Chiropractic Care $30 per treatment; up to 20 visits per year
Dental Care $30 copay per evaluation; up to 2 per year
Rewards Program

Earn $50 for completing the Blue Health Assessment3

Earn up to $120 for completing three eligible Online Health Coach goals3

Services requiring copayment and coinsurance for that covered individual/family will be payable by Florida Blue at the rate of 100% for the remainder of the calendar year, subject to any other terms, limitation, and exclusions. $3,000 Copay per Day / $6,000 maximum Deductible + 50% Coinsurance Inpatient Rehab Services limited to 30 days. Inpatient Habilitation Services limited to 30 days. If you have a hospital stay Physician/surgeon fees $300 Copay per Visit $300 Copay per Visit ––––––––none–––––––– Outpatient services Physician Office: $75. Get Health Insurance plan info on BlueCare Gold 1865 from Florida Blue HMO (a BlueCross BlueShield FL company). Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, hospital services, accepted doctors and more.


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BlueMedicare Premier (HMO) H1035-023 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Florida Blue HMO available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The BlueMedicare Premier (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $2,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $2,500 out of pocket. This can be a extremely nice safety net.

BlueMedicare Premier (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Florida Blue HMO works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueMedicare Premier (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue HMO and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Florida Blue HMO except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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How Much Is Urgent Care Copay With Blue Cross Blue Shield


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2021 Florida Blue HMO Medicare Advantage Plan Costs

Name:
Plan ID:
H1035-023
Provider:Florida Blue HMO
Year:2021
Type: Local HMO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $2,500
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H1035-024

BlueMedicare Premier (HMO) Part-C Premium

Florida Blue HMO plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


H1035-023 Part-D Deductible and Premium

Florida

BlueMedicare Premier (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Florida Blue HMO plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Florida Blue HMO above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Florida Blue Urgent Care Locations


Florida Blue HMO Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Florida Blue HMO plan does offer additional coverage through the gap.


H1035-023 Formulary or Drug Coverage

BlueMedicare Premier (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.



2021 BlueMedicare Premier (HMO) Summary of Benefits



Additional Benefits


No

Urgent Care Copay Without Insurance


Comprehensive Dental


Diagnostic servicesNot covered
EndodonticsNot covered
Extractions$17-72 copay
Non-routine servicesNot covered
Periodontics$34-61 copay
Prosthodontics, other oral/maxillofacial surgery, other services$9-420 copay
Restorative services$15-38 copay


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-100 copay
Diagnostic tests and procedures$0-125 copay
Lab services$0 copay
Outpatient x-rays$0-120 copay


Doctor Visits


Primary$0 copay
Specialist$20 copay per visit


Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$30 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$30 copay
Routine foot careNot covered


Ground Ambulance


$320 copay


Hearing


Fitting/evaluation$0 copay
Hearing aids$0 copay
Hearing exam$20 copay


Inpatient Hospital Coverage


$150 per day for days 1 through 7
$0 per day for days 8 through 90
$0 per day for days 91 and beyond


Medical Equipment/Supplies


Diabetes supplies$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)0-20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item


Medicare Part B Drugs


Chemotherapy20% coinsurance
Other Part B drugs$5 copay or 20% coinsurance


Mental Health Services


Inpatient hospital - psychiatric$275 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit$40 copay
Outpatient group therapy visit with a psychiatrist$40 copay
Outpatient individual therapy visit$40 copay
Outpatient individual therapy visit with a psychiatrist$40 copay


MOOP


$2,500 In-network


Option


No


Optional supplemental benefits


No


Outpatient Hospital Coverage


$100 copay per visit


Preventive Care


$0 copay


Preventive Dental


Cleaning$0 copay
Dental x-ray(s)$0 copay
Fluoride treatmentNot covered
Oral exam$0 copay


Rehabilitation Services


Occupational therapy visit$30 copay
Physical therapy and speech and language therapy visit$30 copay


Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100


Transportation


$0 copay


Vision


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)Not covered
OtherNot covered
Routine eye exam$0 copay
Upgrades$0 copay


Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for BlueMedicare Premier (HMO) H1035


2019 Overall Rating
Part C Summary Rating
Part D Summary 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

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in BlueMedicare Premier (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for BlueMedicare Premier (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

BlueMedicare Premier (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


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Sun 9am-6pm EST



Coverage Area for BlueMedicare Premier (HMO)

(Click county to compare all available Advantage plans)


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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.