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Blue Advantage Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Advantage Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Advantage Premier (PPO) in 2026, please refer to our full plan details page.
Blue Advantage Premier (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 Premier (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 Premier (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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $163.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5100.00 (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 $5100.00 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 Premier (PPO) plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which applies until total drug costs reach $2,100, you will pay a $15 copay for preferred generics and a $42 copay for standard generics at standard pharmacies or via standard mail. For preferred brand and non-preferred drugs, you will pay a 35% and 33% coinsurance respectively. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy will see their Part D premium reduced to $60.10.
Additional Benefits
Blue Advantage Premier (PPO) provides comprehensive medical coverage, featuring no copay for primary care physician visits and a $20 copay for specialist, mental health, and therapy services. For inpatient hospital stays, members pay a $199 daily copay for days one through five, followed by no copay for days six through 90, up to a $995 stay-specific out-of-pocket maximum. Emergency room services require a $130 copay, which is waived if admitted within 24 hours, and ground or air ambulance services have a $175 copay. For routine healthcare needs, the plan offers no copay or coinsurance for Medicare-covered preventive services, a $20 copay for routine eye exams, and a $10 copay for routine hearing exams. Dental coverage includes a $25 copay for Medicare-covered services and a $1,000 annual maximum benefit for other covered dental care. Additionally, durable medical equipment is covered with a 22% coinsurance and no copay, while dialysis services require a 20% coinsurance and no copay.
Inpatient Hospital See details
Blue Advantage Premier (PPO) partially covers inpatient hospital services with a $199 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance, up to a $995 stay-specific out-of-pocket maximum. Non-Medicare-covered stays, acute hospital upgrades, and additional inpatient psychiatric days are not covered.
Outpatient Services See details
Blue Advantage Premier (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $200 for outpatient hospital and observation services. Additionally, there is no copay for ambulatory surgical center services, and outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Blue Advantage Premier (PPO) covers partial hospitalization benefits with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Blue Advantage Premier (PPO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground and air ambulance services require a $175 copay and no coinsurance.
Emergency Services See details
Blue Advantage Premier (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 feature a copay ranging from no copay to $20 and no coinsurance, while worldwide emergency services are covered up to a $50,000 maximum with copays ranging from no copay to $175 and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by Blue Advantage Premier (PPO), with podiatry services and routine chiropractic care excluded from coverage. Covered services feature no coinsurance, with no copay for primary care physician visits, a $15 copay for chiropractic care, a $20 copay for specialists, mental health, and therapy services, and telehealth copays ranging from $0 to $140.
Preventive Services See details
Preventive services are partially covered by Blue Advantage Premier (PPO), featuring no copay or coinsurance for Medicare-covered zero-dollar preventive services. However, several benefits are not covered, including annual physical exams, fitness benefits, and health education.
Hearing Services See details
Blue Advantage Premier (PPO) partially covers hearing services, offering routine hearing exams and fitting evaluations for a $10 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay between $499 and $999 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Blue Advantage Premier (PPO) provides partially covered vision services, including one annual routine eye exam for a $20 copay and no coinsurance. Eyewear has a $100 annual limit with no copay or coinsurance for contact lenses and complete eyeglasses, though separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Blue Advantage Premier (PPO) partially covers dental services, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered services are subject to an annual maximum benefit of $1,000 for both in-network and out-of-network care.
Home Infusion bundled Services See details
Blue Advantage Premier (PPO) covers Home Infusion bundled Services, offering Medicare Part B chemotherapy, radiation, and other Part B drugs with no copay and coinsurance ranging from no coinsurance to 20%. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Blue Advantage Premier (PPO) with no copay and a 20% coinsurance. This coverage ensures you have access to necessary dialysis treatments with clear, predictable out-of-pocket costs.
Medical Equipment See details
Blue Advantage Premier (PPO) covers durable medical equipment, prosthetic devices, and medical supplies with a 22% coinsurance and no copay. For diabetic equipment, some services are covered, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Blue Advantage Premier (PPO) with no coinsurance for covered benefits. Diagnostic procedures, tests, and lab services are not covered, but outpatient x-rays require a $5 copay, and diagnostic and therapeutic radiological services require prior authorization and a $50 copay.
Home Health Services See details
Home Health Services are covered under the Blue Advantage Premier (PPO) plan, allowing you to receive essential medical care right at home. Specific copay and coinsurance costs for these covered services are not detailed in the plan summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Blue Advantage Premier (PPO) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Blue Advantage Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1-20 and days 56-100, and a $125 copay for days 21-55, but the benefit is partially covered as additional days beyond Medicare-covered limits are not covered.
Other Services See details
Blue Advantage Premier (PPO) indicates that some services are covered under the Other Services benefit, but acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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