Secure Blue Courage (PPO)

H1302 - 004 - 0
0 out of 5 stars (0 / 5)

Secure Blue Courage (PPO) is a Medicare Advantage (Part C) Plan by Blue Cross of Idaho.

This page features plan details for 2024 Secure Blue Courage (PPO) H1302 – 004 – 0 available in Select Counties in Idaho.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Secure Blue Courage (PPO) is offered in the following locations.

Plan Overview

Secure Blue Courage (PPO) offers the following coverage and cost-sharing.

Insurer:Blue Cross of Idaho
Health Plan Deductible:$0.00
MOOP:$7,000 In and Out-of-network
$5,200 In-network
Drugs Covered:No

Ready to sign up for Secure Blue Courage (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Secure Blue Courage (PPO) qualifies for a monthly Medicare Give Back Benefit of $50.00.

Premium Reduction:$50.00

Premium Breakdown

Secure Blue Courage (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $50.00 $124.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Secure Blue Courage (PPO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$7,000 In and Out-of-network
$5,200 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

In-network $0-325 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network 20% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary$45 copay per visit (Not applicable.) (Not applicable.)
In-network Specialist$40 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network Specialist$45 copay per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$40 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$30 copay or 10% coinsurance (Authorization is not required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures25% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Lab services$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Lab services25% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0-200 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)25% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$15 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays25% coinsurance (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam$45 copay (Authorization is not required.) (Referral is not required.)
In-network Fitting/evaluation$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Fitting/evaluation$45 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Hearing aids$499-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Hearing aids$499-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Office visit$0.00 (Authorization is not required.) (Referral is not required.)
out-of-network Office visit50% coinsurance (Authorization is not required.) (Referral is not required.)
Oral examCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
CleaningCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatmentCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

In-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Non-routine services50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Restorative services50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Endodontics50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Periodontics50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Extractions50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

In-network Routine eye exam$20 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Routine eye exam$20 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0-35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Contact lenses$35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Upgrades$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Upgrades$35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Rehabilitation services

In-network Occupational therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Occupational therapy visit$45 copay (Authorization is not required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit$45 copay (Authorization is not required.) (Referral is not required.)

Ground ambulance

In-network $275 copay (Not applicable.) (Not applicable.)
out-of-network $275 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Foot exams and treatment$45 copay (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)30% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies$0 copay per item (Authorization is not required.) (Not applicable.)
out-of-network Diabetes supplies30% coinsurance per item (Authorization is not required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy0-30% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs0-30% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs0-30% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $350 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network $350 per day for days 1 through 10
$0 per day for days 11 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$350 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric$350 per day for days 1 through 10
$0 per day for days 11 through 90 (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist25% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist25% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Outpatient group therapy visit$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit25% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit25% coinsurance (Authorization is not required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$203 per day for days 21 through 55
$0 per day for days 56 through 100 (Authorization is required.) (Referral is not required.)
out-of-network $100 per day for days 1 through 12
$203 per day for days 13 through 100 (Authorization is required.) (Referral is not required.)

Ready to sign up for Secure Blue Courage (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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