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Blue Advantage Complete (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Advantage Complete (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Advantage Complete (PPO) in 2026, please refer to our full plan details page.
Blue Advantage Complete (PPO) is a PPO plan offered by BlueCross BlueShield of Alabama available for enrollment in 2025 to people living in State of Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Blue Advantage Complete (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Advantage Complete (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue Advantage Complete (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue Advantage Complete (PPO) plan features an Enhanced Alternative drug benefit with a $200.00 prescription drug deductible. During the initial coverage phase at standard pharmacies and standard mail-order services, you will pay a $20.00 copay for Tier 1 preferred generic drugs and a $47.00 copay for Tier 2 standard generic drugs. Tier 3 preferred brand drugs require a 47% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. Additionally, the plan's Part D premium can be reduced to $7.80 for members who qualify for the low-income subsidy.
Additional Benefits
The Blue Advantage Complete (PPO) plan offers affordable healthcare coverage with a $5 copay for primary care visits and a $30 copay for specialists. Inpatient hospital stays require a $290 daily copay for the first seven days, followed by no copay for days eight through 90. Emergency care is available with a $130 copay, and outpatient services range from no copay to a $315 copay, with no coinsurance for these services. For routine care, the plan provides standard preventive services with no copay, routine hearing exams for a $10 copay, and routine eye exams for a $30 copay. Dental benefits include a $500 annual limit with a $40 copay for Medicare-covered dental services. Durable medical equipment is covered with no copay and a 23% coinsurance, though the plan excludes benefits like fitness programs, transportation, and over-the-counter items.
Inpatient Hospital See details
Blue Advantage Complete (PPO) partially covers inpatient hospital benefits, requiring a copay of $290 per day for days 1 through 7, no copay for days 8 through 90, and no coinsurance. Non-Medicare-covered stays, hospital upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Blue Advantage Complete (PPO) with no coinsurance, featuring copays ranging from no copay to $315 for hospital and observation services, and a $30 copay for substance abuse sessions. Additionally, there is no copay for ambulatory surgical center services, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Blue Advantage Complete (PPO) covers partial hospitalization benefits with a copay of $140.00 and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Blue Advantage Complete (PPO), with ground and air ambulance services requiring a $420 copay and no coinsurance. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Blue Advantage Complete (PPO) covers emergency services with a $130 copay and urgently needed services with a $5 to $30 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with copays ranging from $5 to $420 and no coinsurance.
Primary Care See details
Blue Advantage Complete (PPO) offers primary care benefits with no coinsurance, featuring a $5 copay for primary care provider visits and a $30 copay for specialists and outpatient therapies. While most services are covered, podiatry is not covered, and chiropractic services are only partially covered since routine chiropractic care is excluded.
Preventive Services See details
Preventive services are partially covered by Blue Advantage Complete (PPO), featuring Medicare-covered zero-dollar services with no copay and no coinsurance. While kidney disease education, glaucoma screenings, and remote access technologies are included, the plan does not cover annual physical exams, fitness benefits, health education, and in-home safety assessments.
Hearing Services See details
Blue Advantage Complete (PPO) covers routine hearing exams with a $10 copay and no coinsurance, alongside hearing aid fitting evaluations. Prescription hearing aids are partially covered with a copay of $499 to $999 and no coinsurance for up to two devices per year, but OTC devices and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Blue Advantage Complete (PPO) partially covers vision services with no deductibles, offering one routine eye exam per year for a $30 copay and no coinsurance. Eyewear is covered up to a $100 annual limit with no copay or coinsurance, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Blue Advantage Complete (PPO) provides partially covered dental services with a $500 annual maximum benefit for both in-network and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Blue Advantage Complete (PPO), featuring Medicare Part B insulin drugs for a $35 copay and between no coinsurance and 20% coinsurance. Covered chemotherapy, radiation, and other Part B drugs require no copay and between no coinsurance and 20% coinsurance, though Part D home infusion drugs are not covered as a bundled service.
Dialysis Services See details
Dialysis Services are covered by Blue Advantage Complete (PPO) with 20% coinsurance and no copay.
Medical Equipment See details
Blue Advantage Complete (PPO) partially covers medical equipment, offering durable medical equipment, prosthetic devices, and medical supplies with no copay and a 23% coinsurance. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Blue Advantage Complete (PPO) partially covers Diagnostic and Radiological Services, as diagnostic procedures, tests, and lab services are not covered. Covered services feature no coinsurance, with copays of up to $95 for diagnostic radiological services, up to $60 for therapeutic radiological services, and $15 for outpatient X-ray services.
Home Health Services See details
Blue Advantage Complete (PPO) covers Home Health Services, allowing you to receive essential medical care in the comfort of your home. Specific copay and coinsurance details for these covered services are not provided in this summary.
Cardiac Rehabilitation Services See details
Blue Advantage Complete (PPO) indicates some services are covered, but in practice, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Because these services are excluded, there are no copay or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Blue Advantage Complete (PPO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond Medicare-covered limits are not covered and prior authorization is required. Stays feature no copay or coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100.
Other Services See details
Blue Advantage Complete (PPO) does not cover Other Services, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services.
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