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BlueChoice 65 SELECT PLUS Plan G

BlueChoice 65 SELECT PLUS Plan G, one of our series of Medicare Select plans, offers all features of the BlueChoice 65 and BlueChoice 65 SELECT benefits with additional dental benefits.

Basic Benefits:

Hospital logo

Hospitalization

Part A coinsurance plus coverage for 365 additional days after Medicare benefits end.
Suitcase with medical cross

Medical Expenses

Part B coinsurance (generally 20% of Medicare-approved expenses) or copayments for hospital outpatient services. Plan K, L and N require insureds to pay a portion of Part B coinsurance or copayments.
Drop of blood

Blood

First three pints of blood each year.
Nurse

Hospice

Part A coinsurance.
Tooth

Additional Dental Benefits

Preventive and basic dental services are covered at no cost to you up to $1,200 per year. Some benefits include: oral exams, routine cleanings, horizontal bitewing X-rays, and non-routine, diagnostic and restorative services.

*In order to receive full benefits, dental services must be performed by a United Concordia contracted dental provider in the Advantage Plus network. To find a dentist in the United Concordia contracted dental provider network, visit www.bcbsla.com/findcare and search the dental directory.

Options of BlueChoice 65:

  • Part A deductible coverage
  • Part B deductible coverage
  • Skilled nursing coinsurance
  • Part B coinsurance
  • Part B excess charges

Benefits and Premium Information:

 

Benefit Chart

(Effective June 1, 2010)

Plan Name

A

B

F

G**

N

Here are the basics
Basic, including 100% Part B coinsurance green checkmark green checkmark green checkmark green checkmark 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     green checkmark green checkmark green checkmark
Part A deductible   green checkmark green checkmark green checkmark green checkmark
Part B deductible     green checkmark    
Part B excess (100%)     green checkmark green checkmark  
Foreign Travel Emergency (80%)     green checkmark green checkmark green checkmark

Plan Name

A

Here are the basics
Basic, including 100% Part B coinsurance green checkmark
Skilled nursing facility coinsurance  
Part A deductible  
Part B deductible  
Part B excess (100%)  
Foreign Travel Emergency  

Plan Name

B

Here are the basics
Basic, including 100% Part B coinsurance green checkmark
Skilled nursing facility coinsurance  
Part A deductible green checkmark
Part B deductible  
Part B excess (100%)  
Foreign Travel Emergency  

Plan Name

F

Here are the basics
Basic, including 100% Part B coinsurance green checkmark
Skilled nursing facility coinsurance green checkmark
Part A deductible green checkmark
Part B deductible green checkmark
Part B excess (100%) green checkmark
Foreign Travel Emergency green checkmark

Plan Name

G

Here are the basics
Basic, including 100% Part B coinsurance green checkmark
Skilled nursing facility coinsurance green checkmark
Part A deductible green checkmark
Part B deductible  
Part B excess (100%) green checkmark
Foreign Travel Emergency green checkmark

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 green checkmark
Part A deductible green checkmark
Part B deductible  
Part B excess (100%)  
Foreign Travel Emergency green checkmark
**SELECT PLUS Plan G includes dental services. Advantage Plus Network is administered by United Concordia Companies, Inc. United Concordia is an independent company that administers dental benefits on behalf of Blue Cross and Blue Shield of Louisiana members.

2023-24 Monthly Premium Rates

BlueChoice 65 SELECT PLUS Rates effective May 1, 2023

Area 1 Parishes : all parishes not
in Area 2

Plan Name

G

Age:

Under 65
$369.90
65 $118.60
66-68 $126.90
69-71 $136.40
72-74 $143.60
75-77 $52.60
78-80 $158.50
81+ $162.40
Area 2 Parishes: Orleans, Jefferson, Plaquemines, St. Bernard, St. Charles, St. Tammany and Washington

Plan Name

G

Age:

Under 65
$423.60
65 $133.40
66-68 $143.10
69-71 $154.10
72-74 $162.40
75-77 $172.80
78-80 $179.30
81+ $183.90

 

BlueChoice 65, BlueChoice 65 SELECT, BlueChoice 65 PLUS Plan G, and BlueChoice 65 SELECT PLUS Plan G 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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