A non-government entity
Blue Advantage Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Advantage Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Advantage Plus (PPO) in 2025, please refer to our full plan details page.
Blue Advantage Plus (PPO) is a PPO plan offered by BlueCross BlueShield of Alabama available for enrollment in 2025 to people living in Counties: Hancock Jackson Harrison Stone. The overall rating for this plan is not yet available for 2025.
It's important to know that Blue Advantage 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 Advantage 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 Advantage 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7500.00 (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 $7500.00 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 Advantage Plus (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Advantage Plus (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $13 copay at a preferred pharmacy. Once 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 Advantage Plus (PPO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays require a copay, while outpatient services range from no copay to $240. Emergency services have a $125 copay, and primary care visits range from no copay to a $35 copay. The plan includes coverage for preventive, hearing, vision, and dental services. Preventive services have no copay, hearing exams have a $10 copay, and vision exams have a $25 copay. Dental services have a $25 copay for oral exams, with a $1,000 annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $260 copay for days 1-7 and no copay for days 8-90; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has a $260 copay for days 1-7 and no copay for days 8-90. 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 include coverage for outpatient hospital services and observation services with a copay between $0 and $240, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Advantage Plus (PPO) plan. Both ground and air ambulance services have a $250 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Blue Advantage Plus (PPO) plan. Emergency Services have a $125 copay, and Worldwide Emergency Coverage has a $125 copay, while Worldwide Emergency Transportation has a $250 copay; Urgently Needed Services and Worldwide Urgent Coverage have a copay between $0 and $25. Worldwide Emergency Services has a maximum benefit coverage of $50,000.
Primary Care See details
The Blue Advantage Plus (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $25 copay, and mental health specialty services with a $25 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $55. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Advantage Plus (PPO) plan covers preventive services, including Medicare-covered services with no copay, an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit. Additional preventive services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, and routine hearing exams are covered for one visit per year. Fitting/evaluation for hearing aids is covered, and prescription hearing aids are partially covered, with a copay between $499 and $999 for two hearing aids per year; however, hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $25 copay, and eyewear, including contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered. There is a combined maximum benefit of $290 per year for eyewear.
Dental Services See details
The Blue Advantage Plus (PPO) plan covers dental services including oral exams with a $25 copay, dental x-rays, and other diagnostic dental services. Other covered services include prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with a $1,000 annual maximum benefit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Advantage Plus (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and between 0% and 20% coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Blue Advantage Plus (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Prosthetic Devices are covered with a 23% coinsurance and no copay, while Medical Supplies have a 23% coinsurance and no copay; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Advantage Plus (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $75.00, Therapeutic Radiological Services have a copay of at most $25.00, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Blue Advantage Plus (PPO) plan with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue Advantage Plus (PPO) plan. 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) benefits are covered by the Blue Advantage Plus (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $50 every three months. Acupuncture, Meal Benefits, Dual Eligible SNPs, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved