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Blue Advantage Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Advantage Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Advantage Choice (PPO) in 2026, please refer to our full plan details page.
Blue Advantage Choice (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 Choice (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 Choice (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 Choice (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 has a $285.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $325.00 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 Choice (PPO) plan features an Enhanced Alternative drug benefit with a $325 annual prescription drug deductible. After meeting this deductible, you will pay a $20 copay for Tier 1 preferred generics, 18% coinsurance for Tier 2 standard generics, 30% coinsurance for Tier 3 preferred brands, and 29% coinsurance for Tier 4 non-preferred drugs at standard pharmacies and standard mail services. These initial coverage rates apply for a 30-day supply until your total drug costs reach $2,100. Once your annual out-of-pocket drug expenses exceed $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, plan members who qualify for the low-income subsidy, also known as Extra Help, will pay no copay for their Part D coverage.
Additional Benefits
The Blue Advantage Choice (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring a focus on low copayments and no coinsurance for many services. Inpatient hospital stays require a $330 daily copay for the first seven days and no copay thereafter, while primary care visits have a low $5 copay and specialist visits cost $35. Emergency care carries a $130 copay that is waived upon admission, and outpatient surgical center services are available with no copay. For routine care, members pay no copay for preventive dental services up to a $375 annual limit, alongside a $35 copay for routine eye exams and a $10 copay for hearing exams. Prescription hearing aids are covered with copays ranging from $499 to $999, and eyewear is covered up to $100 annually with no copay. Additionally, medical equipment and dialysis services are covered with coinsurance of 19% and 20% respectively, with no copays.
Inpatient Hospital See details
Blue Advantage Choice (PPO) covers inpatient hospital services with a $330 daily copay for days 1 through 7, no copay for days 8 and beyond, and no coinsurance. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Advantage Choice (PPO) covers outpatient services with no coinsurance, including outpatient blood services with no deductible. Members pay no copay for ambulatory surgical center services, a $35 copay for outpatient substance abuse sessions, and a copay of $0 to $330 for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Blue Advantage Choice (PPO) with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Blue Advantage Choice (PPO), featuring a $420 copay and no coinsurance for both ground and air ambulance services. However, transportation services to plan-approved and other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Advantage Choice (PPO) with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed care has a $5 to $35 copay and no coinsurance, while worldwide emergency services are covered up to a $50,000 maximum with copays ranging from $5 to $420 and no coinsurance.
Primary Care See details
Primary care benefits under Blue Advantage Choice (PPO) are covered with no coinsurance, featuring a $5 copay for primary care visits and a $35 copay for specialists, mental health, and therapy services. Chiropractic services are partially covered with a $15 copay, excluding routine chiropractic care, while podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Blue Advantage Choice (PPO) with no copay and no coinsurance for Medicare-covered zero-dollar services, kidney disease education, and other select screenings. However, the plan does not cover annual physical exams, and additional preventive benefits are only partially covered, excluding services such as fitness benefits, health education, weight management, and therapeutic massages.
Hearing Services See details
Blue Advantage Choice (PPO) provides partially covered hearing services, including one routine hearing exam per year for a $10 copay and no coinsurance. Up to two prescription hearing aids (all types) are covered annually with a copay ranging from $499 to $999 and no coinsurance, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Advantage Choice (PPO) features partially covered vision services, including one annual routine eye exam for a $35 copay and no coinsurance. Eyewear is covered up to a $100 yearly limit with no copay or coinsurance, although individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Blue Advantage Choice (PPO) provides partial dental coverage, featuring Medicare-covered dental services for a $40 copay and no coinsurance, alongside preventive services like cleanings and x-rays with no copay and no coinsurance up to a $375 annual maximum. Comprehensive services, including restorative treatment, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Blue Advantage Choice (PPO), which includes Medicare Part B insulin drugs for a $35 copay and no coinsurance to 20% coinsurance. Medicare Part B chemotherapy, radiation, and other Part B drugs are also covered with no copay and no coinsurance to 19% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Advantage Choice (PPO) plan with 20% coinsurance and no copay.
Medical Equipment See details
Blue Advantage Choice (PPO) partially covers medical equipment, requiring a 19% 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 Choice (PPO) partially covers Diagnostic and Radiological Services, as diagnostic procedures, tests, and lab services are not covered. Covered radiological services require prior authorization and have no coinsurance, with copays of $125 for diagnostic radiological services, $80 for therapeutic radiological services, and $20 for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the Blue Advantage Choice (PPO) plan, though specific copay and coinsurance information is not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Blue Advantage Choice (PPO) does not cover Cardiac Rehabilitation Services, including cardiac, intensive cardiac, and pulmonary rehabilitation, as well as supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD). Because these services are not covered by the plan, there are no associated copayments or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Blue Advantage Choice (PPO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, though additional days beyond those covered by Medicare are not covered. Covered stays require a $10.00 copay and no coinsurance for days 1 through 20, and a $218.00 copay and no coinsurance for days 21 through 100.
Other Services See details
Blue Advantage Choice (PPO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, meal benefits, and highly integrated Dual Eligible SNPs are all excluded from coverage.
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