Networks change. We verify your specific Florida Blue Medicare plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: BlueMedicare, BlueMedicare HMO, BlueMedicare PPO, BlueMedicare Regional PPO, Florida Blue Medicare Advantage, BCBS Medicare Advantage HMO. Offered in Florida.
Florida Blue Medicare is the Medicare Advantage arm of Florida Blue, the Blue Cross Blue Shield licensee for Florida, and it sells BlueMedicare HMO, PPO and Regional PPO plans along with dual-eligible special needs plans across the state, including Palm Beach, Broward, Martin, St. Lucie, Brevard and Duval counties. These plans replace Original Medicare's coinsurance with fixed copays and typically cover outpatient psychiatry, medication management and psychotherapy for a mental health specialist copay with no deductible. Behavioral health benefits for Florida Blue Medicare members are administered by Lucet, formerly New Directions, which maintains the psychiatry network and handles authorizations. HMO members must stay in network but most plans do not require a primary care referral for behavioral health. PPO members can go out of network at a higher cost share.
Telehealth mental health visits from home are typically covered at the same copay as office visits for members located in Florida during the appointment. For Deep TMS, Florida Blue Medicare must cover what Original Medicare covers and applies Medicare's criteria for severe major depressive disorder after failure of at least two antidepressants and a psychotherapy trial, with prior authorization through Lucet required on most plans and a standard course typically approved. Spravato is covered as a Part B drug with prior authorization, with documentation of treatment-resistant depression, a concurrent oral antidepressant and REMS-certified administration. Your cost share for TMS sessions and for the Spravato drug and monitoring visit depends on your plan and may be a copay or a percentage. Our staff verify both before scheduling.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Does Stedfast Psychiatry accept BlueMedicare plans?
Stedfast Psychiatry accepts many Florida Blue Medicare HMO, PPO and dual-eligible plans at our Florida offices. Because behavioral health is administered by Lucet, confirm that our providers appear in the Lucet directory for your plan, or call the mental health number on your card. Our front desk can also run an eligibility check before you schedule.
What will a psychiatry visit cost on Florida Blue Medicare?
Most BlueMedicare plans charge a fixed copay for outpatient mental health specialist visits with no deductible, and dual-eligible special needs plan members typically pay nothing. Telehealth visits usually carry the same copay. Your evidence of coverage lists the exact amount, and our staff can confirm it before your first appointment.
Does Florida Blue Medicare cover telehealth with a psychiatrist?
Yes. BlueMedicare plans cover video mental health visits from home at the same cost share as office visits for members physically located in Florida during the appointment. Telehealth is convenient for medication follow-ups. Deep TMS and Spravato must be delivered in person at Palm Beach Gardens and our other Palm Beach County offices.
Will Florida Blue Medicare authorize Deep TMS or Spravato?
Both are covered under Medicare's criteria, with prior authorization through Lucet required on most plans. TMS requires documented failure of at least two antidepressants and a psychotherapy trial; Spravato requires treatment-resistant depression and a concurrent oral antidepressant. Our team submits the records, follows up until a decision is issued, and confirms your cost share first.