A non-government entity
Blue Cross Medicare Advantage Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Classic (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Classic (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Classic (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in MT Mid PPO. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Classic (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 Cross Medicare Advantage Classic (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 Cross Medicare Advantage Classic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $74.00. 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 $450.00 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 $10100.00 (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 $10100.00 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 Cross Medicare Advantage Classic (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Cross Medicare Advantage Classic (PPO) plan features an annual drug deductible of $450. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay for a one-month supply at preferred locations compared to a $6 copay at standard pharmacies. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brand drugs requiring 17% coinsurance at preferred pharmacies and 19% at standard pharmacies. Tier 4 non-preferred drugs carry a 38% preferred coinsurance or a 41% standard coinsurance. Specialty drugs in Tier 5 require a flat 27% coinsurance for a one-month supply regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for preventive services and primary care telehealth visits. In-person primary care visits require a low $7 copay, while emergency room visits carry a $120 copay with no coinsurance. For hospital stays, inpatient care requires a $375 daily copay for the first six days and no copay thereafter, while outpatient hospital services carry a $400 copay. Routine dental, vision, and hearing exams are available with no copay, though specialized services like prescription hearing aids require copays ranging from $699 to $999. Skilled nursing facility stays feature no copay for days 1 to 20 and a $218 daily copay for days 21 to 49, while home health services are fully covered with no copay. Durable medical equipment and dialysis services generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Classic (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $375 daily copay for days 1 to 6 and no copay for days 7 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is also covered with no coinsurance, featuring a $324 daily copay for days 1 to 5 and no copay for days 6 to 90, while additional psychiatric days and non-Medicare-covered stays are not covered. Prior authorization is required for both inpatient services.
Outpatient Services See details
Blue Cross Medicare Advantage Classic (PPO) covers outpatient hospital services with a $400 copay and no coinsurance, and observation services with a $375 copay per stay and no coinsurance. Ambulatory surgical center services require a $325 copay and no coinsurance, while outpatient substance abuse sessions carry a $75 copay and no coinsurance, and outpatient blood services feature no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Classic (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Classic (PPO) covers ground ambulance services with a $290.00 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. While transportation benefits are technically covered, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Classic (PPO) covers emergency services with a $120 copay (waived if admitted within three days) and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered with a $120 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Classic (PPO) covers primary care visits for a $7 copay and telehealth with no copay, both with no coinsurance. Specialist, therapy, and mental health services are covered with no coinsurance and copays ranging from $30 to $45, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Blue Cross Medicare Advantage Classic (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, diabetes self-management, and fitness benefits. However, additional preventive benefits are only partially covered, excluding services such as health education, personal emergency response systems, weight management, and in-home support.
Hearing Services See details
Blue Cross Medicare Advantage Classic (PPO) provides partially covered hearing services with no coinsurance, including a $45 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are covered for up to two devices per year with a copay of $699 to $999 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Classic (PPO) covers vision services with no deductible and no coinsurance, offering routine eye exams and select eyewear with no copay, and other eyewear with a $45 copay. This plan features a $40 annual maximum for exams and a $100 annual limit for eyewear, though upgrades, combined eyeglasses (lenses and frames), and other eye exams are not covered.
Dental Services See details
Dental services are partially covered by the Blue Cross Medicare Advantage Classic (PPO), with Medicare-covered dental services requiring a $45 copay and no coinsurance. Covered preventive services, including two oral exams, one X-ray, and two cleanings per year, have no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Classic (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, insulin, and other drugs require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Blue Cross Medicare Advantage Classic (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Classic (PPO) covers durable medical equipment, prosthetics, and diabetic services with no copay and a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Classic (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures and lab services feature no coinsurance and copays ranging from no copay up to $50, while outpatient X-rays and therapeutic radiology require a 20% coinsurance.
Home Health Services See details
Blue Cross Medicare Advantage Classic (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Classic (PPO) does not cover Cardiac Rehabilitation Services in practice, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are all not covered. Although there is no coinsurance, these services require prior authorization and carry copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Classic (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and 50 to 100, and a $218 daily copay for days 21 to 49. Prior authorization is required, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Classic (PPO) provides coverage for some services under the Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved