Basic Benefits:
Options of BlueChoice 65:
Benefits and Premium Information:
Benefit Chart
Plan Name |
B |
F |
G |
N |
|---|---|---|---|---|
| Here are the basics | ||||
| Basic, including 100% Part B coinsurance |  |
|
|
Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER |
| Skilled nursing facility coinsurance |  |
|
|
|
| Part A deductible | |
|
|
|
| Part B deductible | |
|||
| Part B excess (100%) | |
|
||
| Foreign Travel Emergency (80%) | |
|
|
|
Plan Name |
B |
||
|---|---|---|---|
| Here are the basics | |||
| Basic, including 100% Part B coinsurance | |
||
| Skilled nursing facility coinsurance | |||
| Part A deductible |
|
||
| Part B deductible | |||
| Part B excess (100%) | |||
| Foreign Travel Emergency | |||
Plan Name |
F |
||
|---|---|---|---|
| Here are the basics | |||
| Basic, including 100% Part B coinsurance | |
||
| Skilled nursing facility coinsurance | |
||
| Part A deductible | |
||
| Part B deductible | |
||
| Part B excess (100%) | |
||
| Foreign Travel Emergency | |
||
Plan Name |
G |
||
|---|---|---|---|
| Here are the basics | |||
| Basic, including 100% Part B coinsurance | |
||
| Skilled nursing facility coinsurance | |
||
| Part A deductible | |
||
| Part B deductible | |||
| Part B excess (100%) | |
||
| Foreign Travel Emergency | |
||
Plan Name |
N |
||
|---|---|---|---|
| Here are the basics | |||
| Basic, including 100% Part B coinsurance | Basic, including 100% Part B coinsurance, except up to $20 copayment for office visit, and up to $50 copayment for ER | ||
| Skilled nursing facility coinsurance | |
||
| Part A deductible | |
||
| Part B deductible | |||
| Part B excess (100%) | |||
| Foreign Travel Emergency | |
||
2024-25 Monthly Premium Rates
Effective May 1, 2024
Plan Name |
B |
F |
G |
N |
|---|---|---|---|---|
Age:Under 65 |
$375.70 | $476.70 | $379.90 | $257.50 |
| 65 | $128.00 | $162.60 | $104.70 | $79.10 |
| 66-68 | $138.80 | $177.00 | $113.80 | $86.00 |
| 69-71 | $151.40 | $193.20 | $124.20 | $94.00 |
| 72-74 | $160.70 | $205.30 | $132.10 | $99.80 |
| 75-77 | $172.20 | $220.80 | $141.90 | $107.30 |
| 78-80 | $179.80 | $230.50 | $148.40 | $112.10 |
| 81+ | $187.50 | $237.20 | $152.60 | $115.20 |
Plan Name |
B |
|---|---|
Age:Under 65 |
$375.70 |
| 65 | $128.00 |
| 66-68 | $138.80 |
| 69-71 | $151.40 |
| 72-74 | $160.70 |
| 75-77 | $172.20 |
| 78-80 | $179.80 |
| 81+ | $187.50 |
Plan Name |
F |
|---|---|
Age:Under 65 |
$476.70 |
| 65 | $162.60 |
| 66-68 | $177.00 |
| 69-71 | $193.20 |
| 72-74 | $205.30 |
| 75-77 | $220.80 |
| 78-80 | $230.50 |
| 81+ | $237.20 |
Plan Name |
G |
|---|---|
Age:Under 65 |
$104.70 |
| 65 | $113.80 |
| 66-68 | $124.20 |
| 69-71 | $132.10 |
| 72-74 | $141.90 |
| 75-77 | $148.40 |
| 78-80 | $152.60 |
| 81+ | $139.40 |
Plan Name |
N |
|---|---|
Age:Under 65 |
$257.50 |
| 65 | $79.10 |
| 66-68 | $86.00 |
| 69-71 | $94.00 |
| 72-74 | $99.80 |
| 75-77 | $107.30 |
| 78-80 | $112.10 |
| 81+ | $115.20 |
Plan Name |
B |
F |
G |
N |
|---|---|---|---|---|
Age:Under 65 |
$433.90 | $550.90 | $438.70 | $297.50 |
| 65 | $147.60 | $188.10 | $120.90 | $91.50 |
| 66-68 | $160.60 | $204.40 | $131.50 | $99.30 |
| 69-71 | $174.80 | $223.20 | $143.60 | $108.50 |
| 72-74 | $185.70 | $237.20 | $152.60 | $115.20 |
| 75-77 | $199.20 | $255.00 | $164.00 | $123.80 |
| 78-80 | $207.70 | $266.10 | $171.10 | $129.20 |
| 81+ | $216.60 | $273.60 | $176.20 | $133.20 |
Plan Name |
B |
|---|---|
Age:Under 65 |
$433.90 |
| 65 | $147.60 |
| 66-68 | $160.60 |
| 69-71 | $174.80 |
| 72-74 | $185.70 |
| 75-77 | $199.20 |
| 78-80 | $207.70 |
| 81+ | $216.60 |
Plan Name |
F |
|---|---|
Age:Under 65 |
$550.90 |
| 65 | $188.10 |
| 66-68 | $204.40 |
| 69-71 | $223.20 |
| 72-74 | $237.20 |
| 75-77 | $255.00 |
| 78-80 | $266.10 |
| 81+ | $273.60 |
Plan Name |
G |
|---|---|
Age:Under 65 |
$438.70 |
| 65 | $120.90 |
| 66-68 | $131.50 |
| 69-71 | $143.60 |
| 72-74 | $152.60 |
| 75-77 | $164.00 |
| 78-80 | $171.10 |
| 81+ | $176.20 |
Plan Name |
N |
|---|---|
Age:Under 65 |
$297.50 |
| 65 | $91.50 |
| 66-68 | $99.30 |
| 69-71 | $108.50 |
| 72-74 | $115.20 |
| 75-77 | $123.80 |
| 78-80 | $129.20 |
| 81+ | $133.20 |
BlueChoice 65 and BlueChoice 65 SELECT are not connected with or endorsed by the U.S. government or the federal Medicare program. Please see your agent for benefit exclusions, limitations and reductions.
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