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Blue Cross Medicare Advantage Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice Plus (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 Choice Plus (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice Plus (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in MT $0 Low 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 Choice Plus (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 Choice Plus (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 Choice Plus (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 $615.00 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 Choice Plus (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Choice Plus (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail order services. Tier 2 generic drugs are also highly affordable, with copays starting at just $1 at preferred pharmacies and $6 at standard pharmacies for a one-month supply. Higher-tier medications are covered through coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 17% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 32% coinsurance. Specialty drugs in Tier 5 require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Cross Medicare Advantage Choice Plus (PPO) plan offers comprehensive medical coverage with predictable costs, including a $10 copay for primary care visits and a $32 copay for specialists, while telehealth services require no copay. For hospital stays, members pay a $400 daily copay for the first five days of inpatient care and no copay thereafter, with no coinsurance. Emergency room visits have a $115 copay, which is waived if admitted, and urgent care visits require a $40 copay. Preventive care, routine eye exams, and home health services are available with no copay and no coinsurance under this plan. Diagnostic tests, hearing aids, and medical equipment are partially covered, though some services like dialysis and durable medical equipment require a twenty percent coinsurance. Routine dental services, eyewear, and routine transportation are not covered by this plan.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $400 daily copay for days 1 to 5 and no copay for days 6 and beyond. Inpatient psychiatric care is also covered with no coinsurance, requiring a $324 daily copay for days 1 to 5 and no copay for days 6 to 90, though psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers outpatient hospital services with a $430 copay and observation services with a $400 copay, both featuring no coinsurance. Ambulatory surgical center services require a $350 copay and no coinsurance, outpatient substance abuse sessions have a $75 copay and no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers ground ambulance services with a $290 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers emergency services with a $115 copay (waived if admitted within 3 days) and urgently needed services with a $40 copay, both with no coinsurance and no deductible. Worldwide emergency and urgent services are partially covered with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers primary care visits with a $10 copay and specialist visits with a $32 copay, both with no coinsurance. Telehealth benefits are available with no copay and no coinsurance, while mental health, physical therapy, and opioid treatments require copays from $30 to $45 and no coinsurance. Chiropractic and podiatry services are not covered by this plan.
Preventive Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) preventive services are partially covered with no copay and no coinsurance for annual exams, fitness benefits, remote access, kidney education, and screenings. Non-covered sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) partially covers hearing services, providing Medicare-covered exams for a $45 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. While up to two prescription hearing aids are covered annually with a copay between $699 and $999 and no coinsurance, OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) vision services are partially covered, featuring one routine eye exam per year with no copay and no coinsurance, up to a $40 annual maximum. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) dental services are partially covered, offering Medicare-covered dental care for a $45.00 copay and no coinsurance. Routine and comprehensive sub-services, such as oral exams, cleanings, x-rays, fluoride, restorative care, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Choice Plus (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copay, though prior authorization is required. Beneficiaries are responsible for a 20% coinsurance for most equipment and supplies, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers diagnostic tests and lab services with no coinsurance and copays ranging from no copay up to $50. Radiological services, including X-rays and therapeutic services, require a minimum 20% coinsurance and applicable copays, with prior authorization required for all services.
Home Health Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) offers Cardiac Rehabilitation Services with no coinsurance, but in practice, the benefit is not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Blue Cross Medicare Advantage Choice Plus (PPO) with no coinsurance, as additional days beyond the standard Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 50 to 100, but a $218 daily copay applies for days 21 to 49, requiring prior authorization but no prior three-day hospital stay.
Other Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) does not cover other supplemental services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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