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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 2025, 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 4 out of 5 stars in 2025.
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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $440.00 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 $7900.00 (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 $7900.00 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 has a $440 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, Tier 1 drugs have a $13 copay at standard mail pharmacies. Once your total drug costs reach $2,000, you enter the Catastrophic Coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Blue Advantage Choice (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $290 copay for the first seven days, and outpatient services with varying copays. You'll find coverage for primary care with no copay, along with specialist visits and therapies, each with their own copay amounts. This plan also includes preventive, hearing, vision, and dental services with copays and some limitations, as well as coverage for ambulance, emergency, and home health services. Medical equipment, dialysis, and home infusion are covered with copays or coinsurance. However, certain services like cardiac rehabilitation, additional home health care, and many "other services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $290 copay for days 1-7, and no copay for days 8-90, while Additional Days are covered with no copay, and Non-Medicare-covered Stays and Upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $290 copay for days 1-7, and no copay for days 8-90, while Additional Days and Non-Medicare-covered Stays are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay of $0-$265, observation services with a copay of $0-$265, 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 under this plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Blue Advantage Choice (PPO) plan. Ground and Air Ambulance Services have a $405 copay, with no coinsurance, while 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 Choice (PPO) plan. Emergency Services have a $125 copay, and Worldwide Emergency Coverage also has a $125 copay. Urgently Needed Services and Worldwide Urgent Coverage have a copay between $0 and $35, and Worldwide Emergency Transportation has a $405 copay.
Primary Care See details
The Blue Advantage Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. This plan also includes coverage for physician specialist services with a $35 copay, mental health specialty services with a $35 copay, and physical therapy and speech-language pathology services with a $30 copay. Additionally, telehealth benefits are covered with a copay ranging from $0 to $55.
Preventive Services See details
The Blue Advantage Choice (PPO) plan covers Medicare-covered preventive services with no copay, and additional preventive services including fitness benefits, enhanced disease management, and remote access technologies. Annual physical exams, health education, and several other services are not covered.
Hearing Services See details
Hearing Services under the Blue Advantage Choice (PPO) plan includes routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $35 copay, and eyewear with a combined maximum benefit of $100 per year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $40 copay for Medicare Dental Services. Other dental services have a maximum plan benefit of $375 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Blue Advantage Choice (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Advantage Choice (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 22% coinsurance and no copay, Prosthetics/Medical Supplies with 22% coinsurance and no copay, and Diabetic Equipment with no copay; however, 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 Choice (PPO) plan, however, 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 $80, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Blue Advantage Choice (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 Choice (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 Choice (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Blue Advantage Choice (PPO) plan. Specific services such as Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, 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, and Self-Directed Personal Assistance Services are not covered.
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