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Blue Cross Medicare Advantage Protect (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Protect (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 Protect (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Protect (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in MT MA Only Buydown 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 Protect (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Cross Medicare Advantage Protect (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 Protect (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (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 $10000.00 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:
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Drug Coverage
Prescription drugs are not covered by Blue Cross Medicare Advantage Protect (PPO).
Additional Benefits
The Blue Cross Medicare Advantage Protect (PPO) plan offers comprehensive coverage featuring no copay for primary care visits, routine preventive services, and home health care. For specialized medical needs, members pay a $50 copay for specialist visits, a $100 copay for emergency room care, and daily copays for inpatient hospital stays with no coinsurance. Outpatient hospital services and ground ambulance transports are also covered under flat copayments with no coinsurance. This plan also includes valuable dental, vision, and hearing benefits, featuring no copay for routine exams and cleanings alongside allowances for glasses and hearing aids. Skilled nursing facility care starts with no copay for the first 20 days, while medical equipment and dialysis services generally require a 20% coinsurance. Overall, this PPO plan minimizes out-of-pocket unpredictability by utilizing fixed copays for most major services and eliminating coinsurance on many key benefits.
Inpatient Hospital See details
Blue Cross Medicare Advantage Protect (PPO) covers inpatient hospital services with no coinsurance, requiring a $370 daily copay for days 1 to 6 of acute stays and a $290 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and certain sub-services such as non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Protect (PPO) covers outpatient services with no coinsurance, featuring a $375 copay for outpatient hospital services, a $370 copay per stay for observation services, and a $300 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $75 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Protect (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services are covered by the Blue Cross Medicare Advantage Protect (PPO) plan with prior authorization, requiring a $350 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Protect (PPO) covers emergency services with a $100 copay and no coinsurance (waived if admitted to the hospital within three days), 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 Protect (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with a $40 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Protect (PPO) provides preventive services, such as annual physicals, fitness benefits, and kidney disease education, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Protect (PPO) offers hearing services with no deductible and no coinsurance, including Medicare-covered exams for a $40 copay and routine annual exams and fitting evaluations with no copay. Prescription hearing aids are partially covered with a copay of $699 to $999 for up to two devices per year, while OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Protect (PPO) with no copay and no coinsurance, offering one routine eye exam and up to a $100 annual allowance for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered under this plan.
Dental Services See details
Blue Cross Medicare Advantage Protect (PPO) dental services are partially covered, offering Medicare-covered dental care for a $35 copay and no coinsurance, alongside preventive services like exams and cleanings for no copay and no coinsurance. Comprehensive benefits are covered up to a $750 annual limit with no copay and coinsurance ranging from no coinsurance up to 50%, though fluoride, implants, orthodontics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Protect (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Blue Cross Medicare Advantage Protect (PPO) with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
Blue Cross Medicare Advantage Protect (PPO) covers medical equipment with no copay, although prior authorization is required for these services. Durable medical equipment, prosthetics, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Protect (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, a $5 copay for lab services, and a $0 to $100 copay for tests, while radiological services require a minimum 20% coinsurance for therapeutic and X-ray services and copays starting at $0 for diagnostic radiology.
Home Health Services See details
Blue Cross Medicare Advantage Protect (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Protect (PPO) covers cardiac rehabilitation services with no coinsurance and required prior authorization, though some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. Covered services under this benefit require no coinsurance, though copayments may apply to select covered rehabilitation services.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Protect (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and 60 to 100, and a $218 daily copay for days 21 to 59. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Protect (PPO) covers some services under its Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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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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