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Blue Advantage Magnolia (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Advantage Magnolia (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Advantage Magnolia (PPO) in 2025, please refer to our full plan details page.
Blue Advantage Magnolia (PPO) is a PPO plan offered by BlueCross BlueShield of Alabama available for enrollment in 2025 to people living in North East Mississippi. The overall rating for this plan is not yet available for 2025.
It's important to know that Blue Advantage Magnolia (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 Magnolia (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 Magnolia (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 Magnolia (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The Blue Advantage Magnolia (PPO) plan offers coverage for a variety of services, including inpatient and outpatient hospital care, with copays ranging from $0 to $275. The plan also covers primary care, preventive, hearing, vision, and dental services, with varying copays and coverage limits. Emergency, ambulance, and home health services are covered as well. Additional benefits include partial hospitalization, dialysis, and medical equipment coverage. The plan also provides coverage for skilled nursing facilities with copays, and other services such as home infusion and cardiac rehabilitation. However, some services like transportation, additional preventive services, and certain dental, hearing, and vision options are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $275 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999.
Outpatient Services See details
Outpatient services are covered by the Blue Advantage Magnolia (PPO) plan, including outpatient hospital services and observation services with a copay between $0 and $280, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient substance abuse services have a $25 copay for both individual and group sessions, and outpatient blood services are covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Advantage Magnolia (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
The Blue Advantage Magnolia (PPO) plan covers ambulance services with no coinsurance, but has a $275 copay for both ground and air ambulance services. 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 Magnolia (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $25. Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a copay between $0 and $25 for Worldwide Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation, with a maximum plan benefit coverage of $50,000.
Primary Care See details
The Blue Advantage Magnolia (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, while occupational therapy services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and other health care professional services have a minimum $25 copay. Physician specialist services and physical therapy and speech-language pathology services have a $25 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
Preventive Services, including Medicare-covered preventive services and annual physical exams, are covered. Additional preventive services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing services with the Blue Advantage Magnolia (PPO) plan include hearing exams with a $10 copay, and routine hearing exams, and fitting/evaluation for hearing aids are covered. Prescription hearing aids are partially covered, with a copay between $499 and $999 for all types of prescription hearing aids, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $25 copay, and eyewear with a combined maximum of $185 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Blue Advantage Magnolia (PPO) plan covers dental services, including Medicare dental services with a $25 copay, and other dental services with a $1,000 maximum benefit per year. 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. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Blue Advantage Magnolia (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Advantage Magnolia (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 23% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices have a 23% coinsurance and no copay. Medical Supplies have a 23% coinsurance with no copay; Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Blue Advantage Magnolia (PPO) plan covers diagnostic and radiological services, but diagnostic procedures/tests and lab services are not covered. Diagnostic Radiological Services have a copay of at most $75, Therapeutic Radiological Services have a copay of at most $25, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Blue Advantage Magnolia (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Advantage Magnolia (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 for SNF are not covered.
Other Services See details
Other Services are covered, but 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. This plan offers Over-the-Counter (OTC) Items with a maximum benefit of $50.00 every three months.
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