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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 2025, 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 Birmingham/Mobile. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $0.00. 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 $150.00 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 $7500.00 (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 $7500.00 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 has a $150 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, you'll pay a $13 copay at preferred pharmacies and $20 at standard pharmacies. Specialty tier drugs have no copay.
Additional Benefits
The Blue Advantage Complete (PPO) plan offers a range of benefits, including inpatient hospital stays with a $290 copay for days 1-7 and no copay for days 8-90, outpatient services with varying copays, and emergency services with a $125 copay. The plan also covers primary care with no copay, hearing exams with a $10 copay, and vision services including eye exams with a $35 copay. Additional benefits include home health services with no copay, skilled nursing facility stays with a copay, and dental services with a $40 copay for Medicare dental services and a $1,000 annual maximum for other dental services. This plan also provides coverage for ambulance services, diagnostic and radiological services, and medical equipment with varying copays and coinsurance amounts. However, certain services like Cardiac Rehabilitation and Other Services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Blue Advantage Complete (PPO) plan. For acute care, there is a $290 copay for days 1-7, and no copay for days 8-90, with an out-of-pocket maximum of $2030, and additional days are covered with no copay. Psychiatric care has the same cost structure, with a $290 copay for days 1-7, and no copay for days 8-90, with an out-of-pocket maximum of $2030. However, non-Medicare-covered stays and upgrades for acute care are not covered, nor are additional days or non-Medicare-covered stays for psychiatric care.
Outpatient Services See details
Outpatient services are covered under the Blue Advantage Complete (PPO) plan, including outpatient hospital services with a copay between $0 and $295, observation services with a copay between $0 and $295, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $35. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Advantage Complete (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Blue Advantage Complete (PPO) plan. This includes both ground and air ambulance services, each with a $320 copay and no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Blue Advantage Complete (PPO) plan. Emergency Services has a $125 copay and no coinsurance, while Urgently Needed Services has a copay between $0 and $35 with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a copay between $0 and $35, and Worldwide Emergency Transportation has a $320 copay; all of these services have no coinsurance.
Primary Care See details
The Blue Advantage Complete (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $35 copay, while physician specialist services and physical therapy/speech-language pathology services each have a $35 copay. Mental health specialty services and psychiatric services have a minimum copay of $35, with the maximum also being $35, while additional telehealth benefits range from a $0 to a $55 copay.
Preventive Services See details
Preventive Services are covered by the Blue Advantage Complete (PPO) plan, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and telemonitoring services are not covered. Other covered services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing exams are covered with a $10 copay. Prescription hearing aids are covered with a copay between $499 and $999, depending on the type.
Vision Services See details
Vision services include coverage for eye exams with a $35 copay, eyewear with a combined maximum of $100 per year, and unlimited contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services for the Blue Advantage Complete (PPO) plan includes coverage for Medicare Dental Services with a $40 copay, while other dental services have a $1,000 maximum benefit per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Blue Advantage Complete (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Advantage Complete (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Blue Advantage Complete (PPO) plan, including Durable Medical Equipment (DME) with 23% coinsurance and no copay, and Prosthetic Devices and Medical Supplies with 23% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Advantage Complete (PPO) plan, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $125, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Blue Advantage Complete (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue Advantage Complete (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Advantage Complete (PPO) plan with a copay of $10 for days 1-20, and a copay of $214 for days 21-100; however, additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services are not covered by the Blue Advantage Complete (PPO) plan, including acupuncture, over-the-counter items, meal benefits, and more. No authorization or referral is required for these services.
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