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Blue Cross Medicare Advantage Choice Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Choice Premier (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice Premier (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Dallas/Austin/Houston Mid PPO. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Choice Premier (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 Cross Medicare Advantage Choice Premier (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 Cross Medicare Advantage Choice Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $96.00. 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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $450.00 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 $10100.00 (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 $10100.00 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 Cross Medicare Advantage Choice Premier (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Choice Premier (PPO) plan features an annual drug deductible of $450. Under this plan, Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through preferred mail order, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay for a one-month supply at preferred locations compared to a $6 copay at standard pharmacies. For higher-tier medications, costs shift to a coinsurance percentage, with Tier 3 preferred brand drugs requiring 17% coinsurance at preferred pharmacies and 19% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% coinsurance at preferred locations and 37% at standard locations, while Tier 5 specialty drugs require 27% coinsurance across all pharmacy options for a one-month supply. Choosing preferred pharmacies and mail-order services under this plan maximizes your savings on prescription drug costs.
Additional Benefits
The Blue Cross Medicare Advantage Choice Premier (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, telehealth, and home health services. For hospital stays, members pay a $350 daily copay for the first six days of inpatient acute care with no copay for additional days, while outpatient hospital services require a $375 copay. Specialist visits, physical therapy, and occupational therapy are also highly accessible with copays ranging from $35 to $50 and no coinsurance. Routine annual hearing, dental, and vision exams are covered with no copay and no coinsurance, though specialty services like prescription hearing aids and Medicare-covered dental care require copayments. Standard medical equipment and dialysis services generally carry a 20% coinsurance, while skilled nursing facility stays offer no copay for the first 20 days. Additionally, covered preventive services and annual physicals are available with no copay, helping members manage their health and minimize out-of-pocket costs.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers inpatient acute hospital stays with no coinsurance and a $350 daily copay for days 1 through 6, followed by no copay for additional days. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $270 daily copay for days 1 through 6, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers outpatient hospital services with a $375 copay and no coinsurance, observation services with a $350 copay per stay, and ambulatory surgical center services with a $350 copay and no coinsurance. Outpatient substance abuse sessions require a $75 copay with no coinsurance, while outpatient blood services have no copay and a 20% coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers ground ambulance services with a $275.00 copay and air ambulance services with a 20% coinsurance, with prior authorization required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are partially covered by Blue Cross Medicare Advantage Choice Premier (PPO) because worldwide emergency transportation is not covered. Covered emergency services require a $130 copay (waived if admitted to the hospital within three days) and no coinsurance, urgently needed services require a $40 copay and no coinsurance, and worldwide emergency and urgent services require a $130 copay and no coinsurance.
Primary Care See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require copays ranging from $35 to $50 with no coinsurance. Mental health, psychiatric, and opioid treatment services are covered with copays up to $35 and no coinsurance, but podiatry is not covered, and chiropractic services are only partially covered since routine and other chiropractic services are excluded.
Preventive Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and various screenings. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers hearing exams with no deductible, requiring a $45 copay for Medicare-covered exams and no copay or coinsurance for routine annual exams and fittings. Prescription hearing aids are partially covered with no coinsurance and copays between $699 and $999, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) features partially covered vision services, offering one routine eye exam per year with no copay and no coinsurance. Eyewear is covered with no coinsurance and a $40 copay (with no copay for contacts, lenses, and frames) up to a $100 annual limit, while upgrades, combined eyeglasses (lenses and frames), and other eye exams are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) partially covers dental services, offering Medicare-covered dental for a $45 copay and no coinsurance, as well as select preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Non-covered services include fluoride, restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is available for a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Choice Premier (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and prior authorization required. Most covered equipment and supplies require a 20% coinsurance, while diabetic supplies range from no coinsurance to a 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services require no coinsurance, offering no copay for lab services and a $0 to $100 copay for diagnostic procedures, while radiological services feature no copay for X-rays and a copay with a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers Cardiac Rehabilitation Services with no coinsurance, although prior authorization is required. While some services are covered, specific programs such as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no coinsurance and do not require a prior three-day hospital stay, though prior authorization is needed. There is no copay for days 1 to 20 and days 60 to 100, a $218 daily copay applies for days 21 to 59, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are covered by the Blue Cross Medicare Advantage Choice Premier (PPO), but in practice only some services are covered, as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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