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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 2025, 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 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 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 $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 Health Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Health Choice (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and where you fill your prescription. For preferred generic drugs, you will pay a $10 copay at preferred pharmacies, and $20 at standard pharmacies. For preferred brand and non-preferred drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Health Choice (PPO) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with various copays, and coverage for ambulance and emergency services, each with its own cost structure. Additionally, this plan includes coverage for primary care, preventive services, hearing, vision, and dental services, with varying copays and coinsurance depending on the specific service. This plan also covers home health services with no copay, and skilled nursing facility stays with copays for certain days. The plan provides coverage for other services such as medical equipment, home infusion, and diagnostic and radiological services, with specific copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, you'll pay a $380 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $290 copay for days 1-6, and no copay for days 7-90. Additional days and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $395, and observation services, with a copay of $380. Ambulatory Surgical Center (ASC) Services have a $300 copay, and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $75.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Health Choice (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $350 copay, while air ambulance services have a 20% coinsurance; 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 Health Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $40 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have a $10 copay. Chiropractic Services are covered with a $20 copay, but routine care is not covered. Occupational Therapy Services have a $40 copay. Physician Specialist Services have a $40 copay. Individual and Group Sessions for Mental Health Specialty Services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $50 copay. Other Health Care Professional services have a copay between $10 and $40. Psychiatric Services have a copay between $40 and $40 for individual and group sessions. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, plus additional preventive services such as fitness benefits and remote access technologies, with no copay. Other services like health education and home-based palliative care are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with a $40 copay for hearing exams and no copay for routine hearing exams or fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and eyewear have no copay, with routine eye exams and contact lenses unlimited, and eyeglass lenses and frames limited to one per year. Eyeglass (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride Treatment, Implant Services, and Orthodontics are not covered. Restorative Services and Adjunctive General Services have no coinsurance, Endodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Prosthodontics (fixed) have 20% coinsurance, while Periodontics and Oral and Maxillofacial Surgery have between 0-20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Health Choice (PPO) plan. This plan requires prior authorization and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying coinsurance. Durable Medical Equipment for use outside the home is not covered. 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, including all diagnostic services, Diagnostic Procedures/Tests, Lab Services, all radiological services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have a $5 copay, Diagnostic Radiological Services have a copay of at most $300, and 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 Health Choice (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Health Choice (PPO) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-59, and no copay for days 60-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $25 every three months; however, acupuncture, meal benefit, 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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