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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 2025, 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 4 out of 5 stars in 2025.
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 $153.00. 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:
Sign up for Blue Advantage Premier (PPO)
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Drug Coverage
The Blue Advantage Premier (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $8 copay at preferred pharmacies, while preferred brand drugs have a 33% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with a Part D premium of $37.80.
Additional Benefits
The Blue Advantage Premier (PPO) plan offers coverage for a range of healthcare services. Inpatient hospital stays have a $175 copay for days 1-5, and no copay for days 6-90. Outpatient services have copays ranging from $0 to $150, with no copay for ambulatory surgical center services. Primary care visits have no copay, and specialist visits have a $20 copay. This plan also covers emergency services with a $120 copay, and ambulance services with a $175 copay. Hearing services include hearing exams with a $10 copay, and prescription hearing aids with a copay between $499 and $999. Vision services include eye exams with a $20 copay, and eyewear with a combined maximum benefit of $100 per year. Dental services have a $25 copay for Medicare dental services, with a $1300 annual maximum.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, there is a $175 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services, with a copay between $0 and $150. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions. Outpatient Blood Services are also covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Advantage Premier (PPO) plan. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $175 copay, with no coinsurance, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Blue Advantage Premier (PPO) plan. Emergency Services have a $120 copay with no coinsurance, Urgently Needed Services have a copay between $0 and $20 with no coinsurance, and Worldwide Emergency Coverage has a $120 copay and no coinsurance, Worldwide Urgent Coverage has a copay between $0 and $20 with no coinsurance, and Worldwide Emergency Transportation has a $175 copay with no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Blue Advantage Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $20 copay. It also covers physician specialist services, mental health specialty services, psychiatric services, and physical therapy and speech-language pathology services, each with a $20 copay, as well as additional telehealth benefits with a copay between $0 and $55. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Advantage Premier (PPO) plan covers preventive services, including Medicare-covered preventive services with no copay, and additional preventive services. 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, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services for the Blue Advantage Premier (PPO) plan include hearing exams with a $10 copay, and prescription hearing aids with a copay between $499 and $999, while other services such as prescription hearing aids for the inner, outer, and over the ear, and OTC hearing aids are not covered. Routine hearing exams are limited to 1 per year, and fitting/evaluation for hearing aids is unlimited.
Vision Services See details
The Blue Advantage Premier (PPO) plan covers vision services, including eye exams with a $20 copay. Eyewear is covered, with a combined maximum benefit of $100 every year for both in-network and out-of-network services, while contact lenses and eyeglasses (lenses and frames) are covered. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Blue Advantage Premier (PPO) plan covers dental services, with a $25 copay for Medicare Dental Services. Other Dental Services have a maximum plan benefit of $1300 per year, including coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Advantage Premier (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. This plan utilizes step therapy.
Dialysis Services See details
Dialysis Services are covered under the Blue Advantage Premier (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment benefits are covered, with 22% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies, 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
The Blue Advantage Premier (PPO) plan covers diagnostic and radiological services. Diagnostic services have no copay, but diagnostic procedures/tests and lab services are not covered. Radiological services require prior authorization, and have a copay. Diagnostic radiological services have a copay of at most $25, therapeutic radiological services have a copay of at most $50, and outpatient X-ray services have a $5 copay.
Home Health Services See details
Home Health Services are covered 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 Premier (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, for days 21-55 the copay is $100, and for days 56-100 there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Blue Advantage Premier (PPO) plan does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $50.00 every three months.
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Every year, Medicare evaluates plans based on a 5-star rating system.
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.
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