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Blue Cross Medicare Advantage Optimum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Optimum (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 Optimum (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Optimum (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 Optimum (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 Optimum (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 Optimum (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $128.00. 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 $8950.00 (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 $8950.00 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 Optimum (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Optimum (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 pharmacy type. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. This plan offers an enhanced alternative drug benefit. If you qualify for the low-income subsidy, your Part D premium will be reduced.
Additional Benefits
The Blue Cross Medicare Advantage Optimum (PPO) plan offers a range of benefits with varying costs. You'll find coverage for hospital stays, outpatient services, and emergency care with copays ranging from $25 to $324, depending on the service. Primary care visits, preventative services, and some vision and dental services have no copay. This plan also includes coverage for hearing exams, prescription hearing aids, and home health services. Additionally, the plan covers ambulance services, diagnostic services, and durable medical equipment with copays or coinsurance. The plan offers other benefits such as over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a copay of $275 for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a copay of $324 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $300 copay, observation services with a $275 copay, and ambulatory surgical center services with a $225 copay. Outpatient substance abuse services have a $75 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Optimum (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Optimum (PPO) plan. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Blue Cross Medicare Advantage Optimum (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $25 copay, and all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Optimum (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services all have a $30 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Optimum (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, including Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. However, some services are not covered, including 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, and Counseling Services.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $45 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered; prescription hearing aids (all types) have a copay between $699 and $999. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and eyewear with a $45 copay. Contact lenses and eyeglass lenses have no copay, while eyeglass frames have no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Optimum (PPO) plan covers dental services, including oral exams with no copay, dental X-rays with no copay, and prophylaxis (cleaning) with no copay. Other services include restorative services with no coinsurance, adjunctive general services with 50% coinsurance, periodontics with 20% coinsurance, and oral and maxillofacial surgery with 20% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered. Endodontics, prosthodontics (removable and fixed), and maxillofacial prosthetics are offered as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B Drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs are covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Blue Cross Medicare Advantage Optimum (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but prior authorization is required. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have a $5 copay. Diagnostic Radiological Services have a copay up to $250, while Therapeutic Radiological and Outpatient X-Ray Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Optimum (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 covered, but the specific services listed are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Optimum (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and Meal Benefit, with OTC items having no copay and a $50 benefit maximum every three months, and meal benefits also have no copay and require a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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