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Blue Cross Medicare Advantage Health Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Health Choice (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 Health Choice (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Health Choice (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in MT Flex Card 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 Health Choice (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 Health Choice (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 Health Choice (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 Health Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Health Choice (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred retail pharmacy or preferred mail-order service, compared to a $5 copay at standard pharmacies for a one-month supply. Tier 2 generic medications are also highly affordable, with a low $1 copay at preferred pharmacies and a $6 copay at standard locations. Brand-name and specialty medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 17% coinsurance at preferred pharmacies and 21% at standard pharmacies, while Tier 4 non-preferred drugs cost 33% or 37% coinsurance respectively. Specialty drugs in Tier 5 carry a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Cross Medicare Advantage Health Choice (PPO) plan offers comprehensive medical coverage featuring low out-of-pocket costs for routine care, including a $6 copay for primary care visits and no copay for telehealth services. Specialist visits require a $45 copay, while emergency room services are covered with a $120 copay. For hospital stays, inpatient services feature daily copays for the first week and no copay for subsequent days, while outpatient hospital services are covered with flat copays and no coinsurance. This plan also includes valuable supplemental benefits, providing routine dental, vision, and hearing exams with no copay or coinsurance, alongside a $25 quarterly allowance for over-the-counter items. Preventive services like annual physicals and fitness benefits are fully covered with no copay. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance, while home health services are available with no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Health Choice (PPO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $415 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $290 daily copay for days 1-6 and no copay for days 7-90.
Outpatient Services See details
Outpatient services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no coinsurance, featuring a $425 copay for outpatient hospital services and a $350 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $75 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Health Choice (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 Health Choice (PPO) covers ground ambulance services with a $350 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers emergency services with a $120 copay and no coinsurance (waived if admitted within 3 days) and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are partially covered with a $120 copay and no coinsurance, excluding worldwide emergency transportation which is not covered.
Primary Care See details
Blue Cross Medicare Advantage Health Choice (PPO) offers primary care visits for a $6 copay and specialist visits for a $45 copay, both with no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with a $40 copay and no coinsurance, while telehealth services feature no copay and no coinsurance. Podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay and no coinsurance for annual physicals, fitness benefits, remote access, kidney education, and screenings. The benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers hearing exams with a $40 copay for Medicare-covered exams and no copay for routine annual exams and fitting evaluations, all with no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year up to $40 and eyewear like contact lenses, eyeglass lenses, and frames up to a combined $100 annually, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Health Choice (PPO) partially covers dental services, offering Medicare-covered dental care with a $35 copay and no coinsurance, and routine exams, cleanings, and x-rays with no copay and no coinsurance. However, fluoride, restorative, endodontic, periodontic, prosthodontic, oral surgery, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while covered insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Dialysis Services with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Health Choice (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Diabetic supplies feature a coinsurance ranging from no coinsurance to 20%, and prior authorization is required for these covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Blue Cross Medicare Advantage Health Choice (PPO) plan, with prior authorization required. Diagnostic tests and lab services feature no coinsurance, with copays ranging from no copay up to $100, while radiological services carry a minimum 20% coinsurance and varying copayments.
Home Health Services See details
Home health services are covered by the Blue Cross Medicare Advantage Health Choice (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Blue Cross Medicare Advantage Health Choice (PPO) with no coinsurance and require prior authorization, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan, carrying copayments ranging from $15.00 to $30.00.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This partially covered benefit features no copay for days 1 through 20 and 60 through 100, and a $218 daily copay for days 21 through 59, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Health Choice (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $25 quarterly allowance. Acupuncture, meal benefits, and naloxone are not covered under this plan.
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