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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 2026, 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 Coastal. This plan received an overall rating of 3 out of 5 stars in 2026.
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 a $320.00 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 $9500.00 (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 $9500.00 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
The Blue Advantage Plus (PPO) Medicare plan features an annual drug deductible of $320. Under this plan, Tier 1 preferred generic drugs are available with no copay for both 1-month and 3-month supplies at standard pharmacies and through standard mail order. Tier 2 generic medications cost a $13 copay for a 1-month supply and a $26 copay for a 3-month supply. For higher-tier medications filled at standard pharmacies or mail order, costs are covered via coinsurance. You will pay a 19% coinsurance for Tier 3 preferred brand drugs, a 31% coinsurance for Tier 4 non-preferred drugs, and a 29% coinsurance for Tier 5 specialty drugs. These coinsurance percentages remain the same for both 1-month and 3-month supply options.
Additional Benefits
The Blue Advantage Plus (PPO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits and a $25 copay for specialist care. For hospital stays, members pay a $300 daily copay for the first seven days of inpatient care and no copay for days eight through 90, with no coinsurance required. Emergency room visits carry a $130 copay that is waived if admitted, while urgent care ranges from no copay to a $25 copay. Ancillary benefits include Medicare-covered preventive services and preventive dental care with no copay, though routine vision exams and fitness benefits are not covered. For specialized needs, home health services require no copay, while dialysis and durable medical equipment carry coinsurance rates of 20% and 23% respectively. Hearing services are also partially covered, offering a $10 copay for routine exams and prescription hearing aid copays ranging from $499 to $999.
Inpatient Hospital See details
Blue Advantage Plus (PPO) partially covers inpatient hospital services with no coinsurance, charging a $300 daily copay for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. Unlimited additional acute hospital days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Advantage Plus (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services have a copay ranging from $0 to $280, while individual and group outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Blue Advantage Plus (PPO) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Blue Advantage Plus (PPO) covers ground and air ambulance services with a $365 copay and no coinsurance, which is not waived upon hospital admission. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Blue Advantage Plus (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no coinsurance and range from no copay to a $25 copay, while worldwide emergency services are covered up to $50,000 with no coinsurance and copays ranging from no copay up to $365.
Primary Care See details
Blue Advantage Plus (PPO) provides primary care and opioid treatment with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $25 copay and no coinsurance. Physical, speech, and occupational therapies have a $40 copay and no coinsurance, and telehealth services range from a $0 to $55 copay with no coinsurance. Podiatry is not covered, and although some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Blue Advantage Plus (PPO) partially covers preventive services with no copay and no coinsurance for Medicare-covered preventive services, kidney disease education, and other screenings. However, annual physical exams and additional preventive services—including fitness, weight management, health education, in-home safety assessments, personal emergency response systems, and counseling—are not covered.
Hearing Services See details
Blue Advantage Plus (PPO) partially covers hearing services, featuring a $10 copay and no coinsurance for routine hearing exams, and unlimited hearing aid fittings. Covered prescription hearing aids require no coinsurance with copays between $499 and $999 for up to two aids per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Blue Advantage Plus (PPO) covers some vision services with no deductibles, requiring a $25 copay and no coinsurance for eye exams, and no copay with a 20% coinsurance for eyewear. However, routine eye exams, other eye exam services, contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Blue Advantage Plus (PPO) plan, featuring Medicare-covered dental with a $30 copay and no coinsurance, and preventive services with no copay and no coinsurance up to a $375 annual maximum. Restorative, endodontics, periodontics, prosthodontics, implants, orthodontics, oral and maxillofacial surgery, maxillofacial prosthetics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Blue Advantage Plus (PPO) covers home infusion bundled services with no copay, though step therapy may apply to associated Part B drugs. Covered Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy, radiation, and other Part B drugs have coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Blue Advantage Plus (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Advantage Plus (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and 23% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Advantage Plus (PPO) with no coinsurance, though diagnostic services are only partially covered because diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require no copay, while radiological services require prior authorization and carry copays of $10 for X-rays, a minimum of $25 for therapeutic radiology, and a minimum of $100 for diagnostic radiology.
Home Health Services See details
Home health services are covered by Blue Advantage Plus (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Blue Advantage Plus (PPO) with no coinsurance, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, carrying copayments ranging from $10 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Advantage Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Blue Advantage Plus (PPO) covers other services, but in practice, key sub-services such as 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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