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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 2025, 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 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 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 $590.00 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 has a $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while preferred brand drugs have a 37% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Choice Plus (PPO) plan offers a range of benefits with varying cost-sharing. You'll find no copays for primary care, preventive services, and many vision and dental services, as well as no copay for home health services. However, services like inpatient hospital stays, outpatient services, and specialist visits come with copays, and some services, such as ambulance and medical equipment, involve coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage, including acute and psychiatric care, requires prior authorization. For Inpatient Hospital-Acute, you'll pay a $400 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $324 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $400 copay. Ambulatory Surgical Center (ASC) Services have a $300 copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $75 and $75.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance, and 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 Choice Plus (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, and Urgently Needed Services have a $35 copay, with no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Choice Plus (PPO) plan covers primary care physician services with no copay and specialist services for a $25 copay. Chiropractic services have a $20 copay, and occupational therapy services have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and Individual and Group sessions for mental health and psychiatric services have a $30 copay. Opioid Treatment Program Services have a $45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay. Other preventive services include Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a copay between $699 and $999 depending on the specific type, while OTC hearing aids, and prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams with no copay. Eyewear has a $45 copay, and includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay; eyeglass frames are limited to one pair per year, and there is a combined maximum benefit of $100 for all eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay. Other dental services include oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay, while fluoride treatment and orthodontics are not covered. Orthodontic Services have a maximum plan benefit of $1,000 per year. Restorative Services have no coinsurance, Adjunctive General Services have a 50% coinsurance, Periodontics and Oral and Maxillofacial Surgery have a 20% coinsurance, while implant services and orthodontics are not covered. Endodontics, Prosthodontics (removable), Maxillofacial Prosthetics, and Prosthodontics (fixed) are optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, you have a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but 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 a 20% coinsurance and Diabetic Supplies with 0-20% coinsurance. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. 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 $325, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Choice Plus (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 by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Choice Plus (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, are not covered.
Other Services See details
Other services include over-the-counter (OTC) items and a meal benefit, with OTC items having no copay and a meal benefit with no copay. Acupuncture, 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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