2027 Medicare Advantage plan
Blue adVantage Platinum (HMO-POS): 2027 benefits and costs
Blue Cross and Blue Shield of Louisiana HMO-POS
CMS plan ID: H6453-018-2 · Plan year: 2027
Blue adVantage Platinum (HMO-POS) is a 2027 Medicare Advantage plan offered by Blue Cross and Blue Shield of Louisiana. It is listed in Louisiana.
2027 plan costs at a glance
Monthly plan premium$249.00
Drug deductible$450.00
In-network medical out-of-pocket maximum$3,500.00
- Organization
- Blue Cross and Blue Shield of Louisiana
- Plan organization
- HMO LOUISIANA, INC.
- Parent company
- Louisiana Health Service & Indemnity Company
- Plan type
- HMO-POS
- Part C premium
- $220.90
- Part D premium
- $28.10
- Prescription drug coverage
- Yes
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- In-network medical deductible
- None
- Combined in/out-of-network medical deductible
- None
- Out-of-network medical deductible
- $500.00
Applies to certain out-of-network supplemental services and certain out-of-network Medicare-covered services.
- In-network medical maximum
- $3,500.00
- Combined in/out-of-network medical maximum
- Not applicable
- Out-of-network medical maximum
- Not applicable
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| 50% coinsurance
| |
| Specialist visit | $25.00 copay
| 50% coinsurance
|
|
| Telehealth | $0.00 to $35.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $150.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| $35.00 copay; 0% to 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| $35.00 copay; 0% to 50% coinsurance
|
|
| Kidney disease education services | $0
| 50% coinsurance
|
|
| Medicare-covered chiropractic | $20.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $25.00 copay
| 50% coinsurance
|
|
| Other health professionals | $0.00 to $25.00 copay; 20% coinsurance
| 50% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–7: $205.00 copay per day Days 8–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–7: $225.00 copay per day Days 8–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $200.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $150.00 copay
| 50% coinsurance
| |
| Hospital observation services | $205.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $0.00 to $150.00 copay
| 50% coinsurance
|
|
| Outpatient blood | $0
| 50% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $30.00 copay
| 50% coinsurance
|
|
| Laboratory services | $0.00 to $35.00 copay
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $280.00 copay
| 50% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 50% coinsurance
|
|
| X-rays | 0% to 20% coinsurance
| 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Partial hospitalization | $60.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $60.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $20.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $20.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $40.00 copay
| 50% coinsurance
|
|
| Mental health, individual sessions | $20.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $20.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $20.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $20.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Occupational therapy | $35.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $35.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $20.00 copay
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $20.00 copay
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $10.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Ground ambulance | $250.00 copay
| $250.00 copay
|
|
| Air ambulance | $260.00 copay
| $260.00 copay
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0
| 50% coinsurance
|
|
| Diabetic shoes and inserts | $0
| 50% coinsurance
|
|
| Diabetic monitors | $0
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Medicare-covered dental | $0.00 copay | 50% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| Other diagnostic dentalAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| FluorideAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| Restorative dental careAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | $0.00 copay | 15% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | $0.00 copay | 15% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | $0.00 copay | 15% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | $0.00 copay | 15% coinsurance
| |
| Oral surgeryAdditional plan benefit | $0.00 copay | 15% coinsurance
| |
| Other dental servicesAdditional plan benefit | $0.00 copay | 15% coinsurance
|
Vision benefits
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $25.00 copay
| 50% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | 50% coinsurance
|
|
| Medicare-covered eyewear | $0.00 copay
| 50% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0
|
|
| Eyeglass lensesAdditional plan benefit | $0.00 copay | $0
|
|
| Eyeglass framesAdditional plan benefit | $0.00 copay | $0
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| UpgradesAdditional plan benefit | Point-of-service | $0
|
|
Hearing benefits
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $0.00 copay
| 50% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0 | $0
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 | 80% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0
| 80% coinsurance
|
|
| Over-the-counter hearing aidsAdditional plan benefit | $0.00 copay
| Not summarized. Check coverage with the plan. |
|
Extra benefits
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| Not summarized. Check coverage with the plan. | |
| Annual physical examAdditional plan benefit | $0
| 50% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0
| Not summarized. Check coverage with the plan. |
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Medicare-covered preventive servicesMedicare-covered care | Point-of-service | 50% coinsurance
|
|
| Glaucoma ScreeningMedicare-covered care | Point-of-service | 50% coinsurance
|
|
| Diabetes Self-Management TrainingMedicare-covered care | Point-of-service | 50% coinsurance
|
|
| Digital Rectal ExamsMedicare-covered care | Point-of-service | 50% coinsurance
|
|
| EKG after a Welcome to Medicare visitMedicare-covered care | Point-of-service | 50% coinsurance
|
|
| Medicare Part B insulinMedicare-covered care | Point-of-service | $35.00 copay; 0% to 50% coinsurance
|
|
Allowances and optional benefits
OTC and Hearing aid
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Over-the-counter health items; Over-the-counter hearing aids
- How benefits are provided
- Catalogue Purchase; Debit Card; Reimbursement
- Advance choice of benefits required
- No
- Shared benefit limit
- $40.00
- How often this limit applies
- Every three months
- Shared limit on visits or trips
- No
Benefits for qualifying members
Diabetic eye exams
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Diabetes
- Covered package services cost $0 until the package limit is reached
- No
- Benefits that apply to reduced cost sharing
- Medicare-covered benefits
- Medicare benefits that apply to reduced cost sharing
- Eye exams (category)
- Applies to out-of-network or point-of-service care
- No
- Some package benefits are exempt from the deductible
- No
- Do you offer reduced Coinsurance?
- No
- Service-specific deductible
- No
- Reduced Copayment?
- Yes
- Types of benefits that apply to the copayment cost sharing
- Medicare-covered benefits
- Medicare-covered benefits that will receive reduced Copayment
- Eye exams (category)
- Minimum Copayment for Eye Exams
- $0.00
- Maximum Copayment for Eye Exams
- $0.00
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.
Preferred retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $12.00 | $24.00 | $36.00 |
| Tier 3Preferred Brand | $45.00 | $90.00 | $135.00 |
| Tier 4Non-Preferred Drug | 50% | 50% | 50% |
| Tier 5Specialty Tier | 28% | Not listed | Not listed |
Standard retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $5.00 | $10.00 | $15.00 |
| Tier 2Generic | $14.00 | $28.00 | $42.00 |
| Tier 3Preferred Brand | $47.00 | $94.00 | $141.00 |
| Tier 4Non-Preferred Drug | 50% | 50% | 50% |
| Tier 5Specialty Tier | 28% | Not listed | Not listed |
Mail-order and other pharmacies
Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.
Preferred mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $12.00 | $24.00 | $36.00 |
| Tier 3Preferred Brand | $45.00 | $90.00 | $135.00 |
| Tier 4Non-Preferred Drug | 50% | 50% | 50% |
| Tier 5Specialty Tier | 28% | Not listed | Not listed |
Standard mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $5.00 | $10.00 | $15.00 |
| Tier 2Generic | $14.00 | $28.00 | $42.00 |
| Tier 3Preferred Brand | $47.00 | $94.00 | $141.00 |
| Tier 4Non-Preferred Drug | 50% | 50% | 50% |
| Tier 5Specialty Tier | 28% | Not listed | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $12.00 |
| Tier 3Preferred Brand | $45.00 |
| Tier 4Non-Preferred Drug | 50% |
| Tier 5Specialty Tier | 28% |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $5.00 |
| Tier 2Generic | $14.00 |
| Tier 3Preferred Brand | $47.00 |
| Tier 4Non-Preferred Drug | 50% |
| Tier 5Specialty Tier | 28% |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
- Initial-coverage prices also apply to drugs exempt from the deductible
- Yes
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 48 county listings across 1 state or territory
Louisiana
- Acadia, Louisiana
- Allen, Louisiana
- Ascension, Louisiana
- Assumption, Louisiana
- Avoyelles, Louisiana
- Beauregard, Louisiana
- Bienville, Louisiana
- Calcasieu, Louisiana
- Caldwell, Louisiana
- Cameron, Louisiana
- Claiborne, Louisiana
- Concordia, Louisiana
- East Baton Rouge, Louisiana
- East Feliciana, Louisiana
- Evangeline, Louisiana
- Grant, Louisiana
- Iberia, Louisiana
- Iberville, Louisiana
- Jackson, Louisiana
- Jefferson Davis, Louisiana
- Jefferson, Louisiana
- Lafayette, Louisiana
- Lafourche, Louisiana
- Livingston, Louisiana
- Madison, Louisiana
- Natchitoches, Louisiana
- Orleans, Louisiana
- Plaquemines, Louisiana
- Pointe Coupee, Louisiana
- Rapides, Louisiana
- Red River, Louisiana
- St. Bernard, Louisiana
- St. Charles, Louisiana
- St. Helena, Louisiana
- St. James, Louisiana
- St. John the Baptist, Louisiana
- St. Landry, Louisiana
- St. Martin, Louisiana
- St. Mary, Louisiana
- St. Tammany, Louisiana
- Tangipahoa, Louisiana
- Terrebonne, Louisiana
- Union, Louisiana
- Vermilion, Louisiana
- Vernon, Louisiana
- Washington, Louisiana
- West Baton Rouge, Louisiana
- West Feliciana, Louisiana