Blue adVantage Giveback (HMO-POS) Medicare Advantage Plan H6453-020-1 • 2026 • Ascension Parish, LA

Blue adVantage Giveback Overview

Coverage Overview for Blue adVantage Giveback

This Medicare Advantage MAPD HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $0.00, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $300.00.

Primary care visits have a $0 copay | Out-of-network: 50% coinsurance, specialist visits come with a $50 copay | Out-of-network: 50% coinsurance, urgent care services carry a $50 copay, and ambulance transportation is $250 copay | Out-of-network: $250 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6500.00. After this limit is reached, in-network services are fully covered.

This plan is registered with CMS under Plan ID H6453-020-1. A summary of cost sharing is provided below.

Out-of-Pocket Costs

Blue adVantage Giveback includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H6453-020-1.

Certain preventive services are covered 100% by Blue adVantage Giveback as a Part B benefit.

Prescription Drug Coverage

Blue adVantage Giveback includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $300.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Cross and Blue Shield of Louisiana starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Blue adVantage Giveback may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS 5-Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.