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Blue Advantage Capital (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Advantage Capital (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Advantage Capital (PPO) in 2025, please refer to our full plan details page.
Blue Advantage Capital (PPO) is a PPO plan offered by BlueCross BlueShield of Alabama available for enrollment in 2025 to people living in Counties: Hinds Madison Rankin. The overall rating for this plan is not yet available for 2025.
It's important to know that Blue Advantage Capital (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 Capital (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 Capital (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:
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Drug Coverage
The Blue Advantage Capital (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For example, preferred generic drugs have a $5 copay at preferred pharmacies and no copay at preferred mail-order pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Blue Advantage Capital (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, with no copay for the rest of the stay. Outpatient services and primary care visits often have copays, while preventive services, home health, and some medical equipment have no copay. This plan includes coverage for hearing, vision, and dental services, each with specific copays and annual limits. Emergency services and ambulance services are covered with copays, and there's also coverage for home infusion and dialysis services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 7 days of Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $260 copay, and days 8-90 have no copay; additional days for Inpatient Hospital-Acute have no copay, and Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays 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 $280, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $25 copay for both Individual and Group Sessions, and Outpatient Blood Services. The plan also waives the three-pint deductible for Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Advantage Capital (PPO) plan with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Advantage Capital (PPO) plan. Medicare-covered ground and air ambulance services have a $360 copay, and there is no coinsurance. 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 Blue Advantage Capital (PPO). Emergency Services have a $125 copay with no coinsurance. Urgently Needed Services have a $0-$25 copay with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $0-$25 copay, and Worldwide Emergency Transportation has a $360 copay, all with no coinsurance.
Primary Care See details
The Blue Advantage Capital (PPO) plan covers primary care physician services with no copay, 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. Physical therapy and speech-language pathology services have a $35 copay, while additional telehealth benefits have a copay between $0 and $55. This plan does not cover podiatry services, and routine chiropractic care is not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered with no copay. Additional preventive services, such as health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, and routine hearing exams are covered for one visit every year. Prescription hearing aids are covered with a copay between $499 and $999 for two visits every year, 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 with a $25 copay, and coverage for eyewear, including contact lenses and eyeglasses (lenses and frames), up to a combined maximum of $230 per year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, as well as other dental services. Other dental services have a maximum plan benefit of $1,000 per year for both in-network and out-of-network services. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance, while the other drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Blue Advantage Capital (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered under the Blue Advantage Capital (PPO) plan, with no copay and a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies, but 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 partially covered by the Blue Advantage Capital (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of up to $75, Therapeutic Radiological Services have a copay of up to $30, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Blue Advantage Capital (PPO) plan with no copay and no coinsurance, but 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 Capital (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Advantage Capital (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, 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 offered by Blue Advantage Capital (PPO) include Over-the-Counter (OTC) Items with a maximum benefit coverage of $50 every three months, while acupuncture, meal benefits, 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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