BlueMedicare Preferred (PFFS)

Medical Deductible

$1,000 (out-of-network in Arkansas)

Doctor Office Visits

$10 copay

Specialist Office Visit

$40

Telehealth

$0 copay for urgently needed services, primary care provider services, specialist services, and outpatient mental health (mental health specialty and psychiatry - individual and group sessions).

Inpatient Hospital Care

$390 copay per day for days 1-5.

$0 copay per day for days 6-90.

Comprehensive dental benefits

$3,000 per year for comprehensive (and preventive) dental services.Please see plan documents for more details.

Comprehensive hearing benefits

$0 copay for 1 routine hearing exam per year.

$699/$999 copay per hearing aid (2 per year).

Please see plan documents for more details.

Comprehensive vision benefits

$0 copay for 1 routine eye exam per year.

$150 per year for routine eyewear ( contacts, eyeglasses, and upgrades).

Please see plan documents for more details.

Nations Benefits Card (Over-the-Counter Items)

$25 per quarter, no rollover

24/7 Nurse Hotline

Access to the Nurse24 nurse advice line 24 hours a day, seven days a week, 365 days a year. Registered nurses can provide information on home treatment of minor illnesses and injuries, how to prepare for doctor visits, how to understand your prescription drugs, and much more.

SilverSneakers® fitness program

Access to a fitness benefit virtually and at participating SilverSneakers facilities, giving you access to instructor-led group exercise classes, exercise equipment, and options to get active outside of traditional gyms, as well as virtual options.

In-Network Maximum Out-of-Pocket

$7,500

Combined In- and Out-of-Network Maximum Out-of-Pocket

$7,500.00

Doctor Office Visits

$20 copay out-of-network out-of-state.

40% coinsurance after deductible out-of-network in Arkansas.

Specialist Office Visits

$50 copay out-of-network out-of-state.

40% coinsurance after deductible out-of-network in Arkansas.

Inpatient Hospital Care

Out-of-network out-of-state:

$390 copay per day for days 1-5

$0 copay per day for days 6-90

Out-of-network in Arkansas:

40% coinsurance after deductible

Prescription deductible

$615 on Tier 2, Tier 3, Tier 4, and Tier 5

Out-of-Pocket

$2,100

One-Month Supply (Retail Pharmacy) with Standard Cost Sharing

Preferred Generic

$12.50 copay

Generic

$30 copay

Preferred Brand

20% coinsurance

Non-Preferred Drug

30% coinsurance

Specialty Tier

25% coinsurance

Insulin Products

Lesser of a $35 copay or 20% coinsurance on Tier 3 and the lesser of a $35 copay or 25% coinsurance on Tier 4 and 5 for a one-month supply

100-Day Supply (Retail Pharmacy) with Standard Cost Sharing

Preferred Generic

$12.50

Generic

$30

Preferred Brand

20% coinsurance

Non-Preferred Drug

30% coinsurance

Specialty Tier

Not covered

Insulin Products

Lesser of a $70 copay or 20% coinsurance on Tier 3 and the lesser of a $70 copay or 25% coinsurance on Tier 4 for a two-month supply

Lesser of a $105 copay or 20% coinsurance on Tier 3 and the lesser of a $105 copay or 25% coinsurance on Tier 4 for a three-month supply

Summary of Benefits

BlueMedicare Preferred (PFFS) 2026 Summary of Benefits

Plan Documents

BlueMedicare Preferred (PFFS) Plan Documents