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Blue Cross Medicare Advantage Dental Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dental Premier (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in MT Enhanced Dental 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 Dental Premier (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 Dental Premier (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 Dental Premier (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 $13900.00 (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 $13900.00 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 Dental Premier (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Dental Premier (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay for a one-month supply at preferred locations. For higher-tier medications, costs transition to coinsurance, starting at 17% for Tier 3 preferred brand drugs at preferred pharmacies. Tier 4 non-preferred drugs carry a coinsurance of 33% to 35% depending on your choice of pharmacy, while Tier 5 specialty drugs require a flat 25% coinsurance for a one-month supply. Choosing preferred pharmacies and mail-order services consistently offers the lowest out-of-pocket expenses under this plan.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, telehealth, and annual preventive services. For emergency care, members pay a $100 copay, while inpatient hospital stays require a $400 daily copay for the first six days followed by no copay for subsequent days. Outpatient services and specialist visits are also covered, requiring copays ranging from $35 to $425 with no coinsurance. This plan highlights valuable supplemental benefits, including preventive dental and routine vision care with no copay or coinsurance. Comprehensive dental services are covered up to a $3,000 annual maximum with a 0% to 20% coinsurance, and routine hearing exams are available with no copay. Additionally, home health services feature no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers inpatient acute hospital stays with no coinsurance, a $400 daily copay for days 1 to 6, and no copay for days 7 to 90 with unlimited additional days. Inpatient psychiatric stays are also covered with no coinsurance and a $290 daily copay for days 1 to 6, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers outpatient services with no coinsurance, though prior authorization is required for most services. Covered benefits include outpatient hospital services with a $425 copay, observation services at $400 per stay, ambulatory surgical center visits at $350, outpatient substance abuse sessions at $75, and outpatient blood services with no copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) covers ground ambulance services with a $350 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers emergency services with a $100 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $100 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $35 to $40 copay and no coinsurance. Opioid treatment services have a $50 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, providing fitness benefits and remote access technologies with no copay and no coinsurance, while sub-services like health education, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing Services under Blue Cross Medicare Advantage Dental Premier (PPO) are partially covered with no deductibles or coinsurance, featuring a $40 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are limited to two per year with copays between $699 and $999 and no coinsurance, though 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 Dental Premier (PPO) provides partially covered vision services with no copay, no deductible, and no coinsurance for routine eye exams and select eyewear up to a $100 annual maximum. While contact lenses, individual eyeglass lenses, and frames are covered, other eye exams, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by Blue Cross Medicare Advantage Dental Premier (PPO), offering Medicare-covered dental for a $35 copay and no coinsurance, alongside preventive care with no copay and no coinsurance. Other covered comprehensive services have no copay and 0% to 20% coinsurance up to a $3,000 annual maximum, while other diagnostic services, fluoride, other preventive services, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Dental Premier (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers durable medical equipment, prosthetics, and diabetic services with no copay and generally a 20% coinsurance, though diabetic supplies range from no coinsurance up to a 20% coinsurance. Prior authorization is required for these covered medical equipment benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic services, a $5 copay for lab tests, and up to a $100 copay for other diagnostic procedures. Radiological services, including outpatient X-rays and therapeutic radiology, require a minimum 20% coinsurance, while diagnostic radiology has no copay but is subject to coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) with no coinsurance and require prior authorization, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered, despite listed copayments ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 60 to 100, but a $218 daily copay applies for days 21 to 59; additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Blue Cross Medicare Advantage Dental Premier (PPO), as acupuncture, over-the-counter items, and meal benefits are all excluded from coverage.
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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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