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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 Birmingham/Mobile. 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 $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 $370.00 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 $10000.00 (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 $10000.00 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 an annual prescription drug deductible of $370.00. After meeting this deductible, you will enter the initial coverage phase where standard retail pharmacy and standard mail orders for a 30-day supply cost a $20.00 copay for Tier 1 preferred generics and a $45.00 copay for Tier 2 standard generics. Higher-tier medications require coinsurance, which is set at 44% for Tier 3 preferred brands and 28% for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for covered Medicare Part D drugs. Additionally, individuals who qualify for the Low-Income Subsidy (LIS) can benefit from no Part D premium.
Additional Benefits
The Blue Advantage Complete (PPO) plan provides comprehensive medical coverage with predictable out-of-pocket costs, including a $5 copay for primary care visits and a $35 copay for specialists. Inpatient hospital stays require a $330 daily copay for the first seven days with no copay for subsequent days, while emergency services carry a $130 copay. Outpatient services feature copays ranging from no copay up to $345, and ambulance services require a $350 copay with no coinsurance. For specialized care, the plan offers routine hearing and vision exams with copays of $10 and $35, alongside a $40 copay for Medicare-covered dental services. Durable medical equipment and dialysis services require coinsurance of 23% and 20% respectively with no copays. Additionally, skilled nursing facility stays are covered with a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Blue Advantage Complete (PPO) partially covers inpatient hospital services, requiring a $330 daily copay for days 1 through 7 and no copay or coinsurance for days 8 and beyond. Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Blue Advantage Complete (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and a $0 to $345 copay for outpatient hospital and observation services. Outpatient substance abuse services require a $35 copay per session, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered under Blue Advantage Complete (PPO) with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Blue Advantage Complete (PPO) covers Medicare-covered ground and air ambulance services with a $350 copay and no coinsurance per service, which is not waived if you are admitted to the hospital. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Advantage Complete (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $5 to $35 copay with no coinsurance, while worldwide emergency services are covered up to $50,000 with copays ranging from $5 to $350 and no coinsurance.
Primary Care See details
Blue Advantage Complete (PPO) covers primary care doctor visits for a $5 copay and specialist visits for a $35 copay, with no coinsurance required. Chiropractic care is partially covered with a $15 copay, excluding routine chiropractic services, while podiatry services are not covered under this benefit.
Preventive Services See details
Preventive services are partially covered by Blue Advantage Complete (PPO) with no copay and no coinsurance for Medicare-covered zero-dollar services, kidney disease education, and select screenings. However, several services are not covered under this plan, including annual physical exams, fitness benefits, health education, weight management, and in-home safety assessments.
Hearing Services See details
Blue Advantage Complete (PPO) partially covers hearing services, featuring a $10 copay and no coinsurance for one annual routine hearing exam, unlimited fitting evaluations, and a $499 to $999 copay with no coinsurance for up to two annual prescription hearing aids. Over-the-counter (OTC) hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Blue Advantage Complete (PPO) offers partially covered vision services, which include one routine eye exam per year for a $35 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $100 annual maximum, though eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Blue Advantage Complete (PPO) provides partially covered dental services, with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require a $40 copay and no coinsurance, and other covered dental benefits are subject to a $680 annual maximum for both in- and out-of-network care.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Blue Advantage Complete (PPO), with chemotherapy, radiation, and other Part B drugs requiring no copay and coinsurance ranging from no coinsurance to 20%. Covered Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Blue Advantage Complete (PPO) covers Dialysis Services with 20% coinsurance and no copay.
Medical Equipment See details
Medical equipment is partially covered by Blue Advantage Complete (PPO), requiring a 23% coinsurance and no copay for durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this plan.
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 radiological services require no coinsurance and feature a $125 copay for diagnostic radiological services, a $60 copay for therapeutic radiological services, and a $20 copay for outpatient X-rays.
Home Health Services See details
Home health services are covered under the Blue Advantage Complete (PPO) plan.
Cardiac Rehabilitation Services See details
Blue Advantage Complete (PPO) indicates that some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice. Because these services are not covered, there are no active copay or coinsurance benefits available for them.
Skilled Nursing Facility (SNF) See details
Blue Advantage Complete (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Prior authorization is required, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
Other Services are not covered by the Blue Advantage Complete (PPO) plan, which excludes coverage for acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs.
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