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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 2026, 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. This plan received an overall rating of 3 out of 5 stars in 2026.
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 a $325.00 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 Magnolia (PPO) plan features an annual drug deductible of $325. For Tier 1 preferred generic drugs, members pay no copay for 1-month or 3-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a $13 copay for a 1-month supply and a $26 copay for a 3-month supply through standard pharmacies and mail order. Higher-tier medications are subject to coinsurance rather than set copays through standard pharmacy and standard mail order services. Tier 3 preferred brand drugs require a 19% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance. Specialty drugs in Tier 5 require a 29% coinsurance for both 1-month and 3-month supplies.
Additional Benefits
The Blue Advantage Magnolia (PPO) plan offers robust coverage for essential medical services with predictable cost-sharing. Members enjoy no copays and no coinsurance for primary care visits, home health services, and select outpatient services. Specialist visits require a $25 copay, while inpatient hospital stays have a $275 copay for the first seven days and no copay for days eight through 90. Emergency room visits require a $130 copay, which is waived upon admission, while urgent care costs range from no copay to $25. Dental care is covered with no copay up to a $1,000 annual limit, and hearing exams are available for a low $10 copay. Major medical needs like durable medical equipment and dialysis services feature a 20% coinsurance and no copay.
Inpatient Hospital See details
Blue Advantage Magnolia (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $275 copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute care days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Advantage Magnolia (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay and no deductible. Outpatient hospital and observation services have a copay ranging from $0 to $250, while individual and group substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Blue Advantage Magnolia (PPO) covers partial hospitalization services with a $55 copay and no coinsurance.
Ambulance and Transportation Services See details
Blue Advantage Magnolia (PPO) covers Medicare-covered ground and air ambulance services with a $275 copay and no coinsurance. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Advantage Magnolia (PPO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require no coinsurance and a copay ranging from no copay to $25, while worldwide emergency services are covered up to a $50,000 maximum with no coinsurance and copays ranging from no copay to $275.
Primary Care See details
Blue Advantage Magnolia (PPO) covers primary care provider visits and opioid treatment services with no copay and no coinsurance. Specialist visits, mental health sessions, and physical or occupational therapy require a $25 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Blue Advantage Magnolia (PPO), offering Medicare-covered preventive services, kidney disease education, and select screenings with no copay and no coinsurance. However, annual physical exams and additional preventive benefits, such as fitness programs and health education, are not covered.
Hearing Services See details
Blue Advantage Magnolia (PPO) covers hearing exams with a $10 copay and no coinsurance, including one routine exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $999 for up to two devices per year, though inner, outer, and over-the-ear prescription models, as well as OTC hearing aids, are not covered.
Vision Services See details
Blue Advantage Magnolia (PPO) vision services feature a $25 copay and no coinsurance for eye exams, alongside no copay and 20% coinsurance for eyewear, with no deductibles. However, these benefits are not covered in practice as routine eye exams, other eye exams, contact lenses, and eyeglasses are all not covered.
Dental Services See details
Blue Advantage Magnolia (PPO) offers partially covered dental services with a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $1,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Advantage Magnolia (PPO) covers home infusion bundled services with no copay, though associated Medicare Part B chemotherapy, radiation, and other Part B drugs are subject to a coinsurance ranging from no coinsurance to 20%. Covered Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Advantage Magnolia (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under Blue Advantage Magnolia (PPO) cover Durable Medical Equipment (DME) and prosthetics with no copay and a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Blue Advantage Magnolia (PPO) partially covers diagnostic and radiological services with no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Diagnostic services have 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 $50 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Blue Advantage Magnolia (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Blue Advantage Magnolia (PPO) covers cardiac rehabilitation services with no coinsurance, but in practice only some services are covered; specific services such as cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $20 copay), pulmonary rehabilitation (with a $15 copay), and SET for PAD services (with a $10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Advantage Magnolia (PPO) covers Skilled Nursing Facility (SNF) services 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, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Blue Advantage Magnolia (PPO) provides coverage for other services, meaning some services are covered, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. Since these specific benefits are excluded under the plan, there are no copays or coinsurance costs associated with them.
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