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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 2025, 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 Montana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $45.00. 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 $9950.00 (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 $9950.00 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)
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Drug Coverage
The Blue Cross Medicare Advantage Classic (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services, and emergency care. You can also expect coverage for primary care visits with a low copay, along with vision and dental services, and home health services with no copay. The plan also covers hearing exams, and prescription hearing aids. The plan also covers ambulance services, diagnostic and radiological services, and skilled nursing facility stays. However, some services like cardiac rehabilitation, podiatry, and additional hours of care are not covered. It's important to note that some services require prior authorization, so review the details to understand the coverage and associated costs.
Inpatient Hospital See details
The Blue Cross Medicare Advantage Classic (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you have a $375 copay for days 1-6 and no copay for days 7-90. For Inpatient Hospital Psychiatric, you have a $324 copay for days 1-5 and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan, including outpatient hospital services with a $395 copay, observation services with a $375 copay, and ambulatory surgical center services with a $275 copay. Outpatient substance abuse services and outpatient blood services are also covered, with a $75 copay for individual and group substance abuse sessions and no copay for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Classic (PPO) plan, but requires prior authorization. You will pay a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Classic (PPO) plan, with copays of $120, $30, and $120 respectively, and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Classic (PPO) plan covers primary care physician services with a $7 copay, chiropractic services with a $20 copay (prior authorization required, but routine care is not covered), occupational therapy services with a $40 copay, physician specialist services with a $40 copay (prior authorization required), and mental health specialty services with a $30 copay for individual and group sessions (prior authorization required). The plan does not cover podiatry services, but does cover other health care professionals with a copay between $7 and $40 (prior authorization required), psychiatric services with a $30 copay for individual and group sessions (prior authorization required), physical therapy and speech-language pathology services with a $40 copay (prior authorization required), additional telehealth benefits with no copay, and opioid treatment program services with a $40 copay (prior authorization required).
Preventive Services See details
The Blue Cross Medicare Advantage Classic (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a copay between $699 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 includes coverage for eye exams with no copay, and eyewear with a $45 copay. Routine eye exams are covered with no copay, and you are allowed one exam per year. Contact lenses and eyeglass lenses are covered with no copay, while eyeglass frames are covered with no copay and you are allowed one frame per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Restorative Services are covered with no coinsurance, while Adjunctive General Services are covered with a 50% coinsurance, and Oral and Maxillofacial Surgery is covered with a 20% coinsurance. Fluoride Treatment, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Classic (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, with Diabetic Supplies having between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts having 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, and lab services with a $5 copay. Radiological services include diagnostic radiological services with a copay up to $250, therapeutic radiological services with at most 20% coinsurance, and outpatient X-ray services with at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Classic (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 Cross Medicare Advantage Classic (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 50-100, but there is a $214 copay for days 21-49. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services offered by the Blue Cross Medicare Advantage Classic (PPO) plan include a meal benefit with no copay, while acupuncture, over-the-counter items, 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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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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