BlueMedicare PPO - Florida Blue

Benefit Original Medicare BlueMedicare PPOPreventive Services22. Bone Mass Measurement(for people with Medicare whoare at risk)23. Colorectal ScreeningExams(for people with Medicare age50 and older)24. Immunizations(Flu vaccine, Hepatitis B vaccine– for people with Medicare whoare at risk, Pneumonia vaccine)25. Mammograms (AnnualScreening)(for women with Medicare age40 and older)• 20% coinsurance• Covered once every 24 months (more often ifmedically necessary) if you meet certainmedical conditions.• 20% coinsurance• Covered when you are high-risk or when youare age 50 and older.• $0 copay for Flu and Pneumonia vaccines• 20% coinsurance for Hepatitis B vaccine• You may only need the Pneumonia vaccineonce in your lifetime. Call your doctor formore information.• 20% coinsurance• No referral needed.• Covered once a year for all women withMedicare age 40 and older. One baselinemammogram covered for women withMedicare between age 35 and 39.11In-Network• $0 copay for Medicare-covered bone massmeasurement.Out-of-Network• $50 copay for Medicare-covered bone massmeasurementIn-Network• $0 copay for- Medicare-covered colorectal screenings and- additional screenings• No limit on the number of covered colorectalscreenings.Out-of-Network• $50 copay for colorectal screeningsIn-Network• $0 copay for Flu and Pneumonia vaccines• $0 copay for Hepatitis B vaccine• No referral needed for Flu and Pneumoniavaccines.Out-of-Network• $50 copay for immunizationsIn-Network• $0 copay for- Medicare-covered screening mammogramsand- additional screening mammograms• No limit on the number of covered screeningmammograms.Out-of-Network• $0 copay for screening mammograms