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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 2025, 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, Houston, and Austin Markets. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $95.00. 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 $250.00 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 has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you will pay a $10 copay at a preferred pharmacy, and a $20 copay at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Choice Premier (PPO) plan offers a variety of benefits. This plan covers inpatient hospital stays with a copay, and outpatient services including those at a hospital or ambulatory surgical center. Emergency, primary care, and preventive services are covered with no copay, while specialist visits have a copay. Additional benefits include hearing, vision, and dental services, with copays varying by service. The plan also covers home health, medical equipment, and diagnostic services, as well as skilled nursing facility stays. However, services like cardiac rehabilitation, other services, and transportation are not covered by this plan.
Inpatient Hospital See details
The Blue Cross Medicare Advantage Choice Premier (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $270 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $325 copay, and observation services, with a $275 copay. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services have a $75 copay for individual and group sessions. Outpatient blood services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Blue Cross Medicare Advantage Choice Premier (PPO) plan covers ambulance services, with a $275 copay for ground ambulance services and a 20% coinsurance for 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 Coverage are covered under the Blue Cross Medicare Advantage Choice Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $100 copay, while Urgently Needed Services have a $40 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $15 copay, but routine care is not covered. Occupational Therapy Services are covered with a $40 copay. Physician Specialist Services are covered with a $35 copay. Mental Health Specialty Services are covered with a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services are covered with a $40 copay. Additional Telehealth Benefits are covered with no copay. Opioid Treatment Program Services are covered with a $35 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Some preventive services such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $699 and $999, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
The Blue Cross Medicare Advantage Choice Premier (PPO) plan covers vision services including eye exams with no copay, and eyewear. Eyewear has a $40 copay, with a combined maximum of $100 per year for both in-network and out-of-network services. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include a $45 copay for Medicare dental services, and no copay for oral exams, dental x-rays, and prophylaxis (cleaning). Fluoride treatment and orthodontics are not covered, and there is a 20% coinsurance for endodontics, prosthodontics (removable, and fixed), maxillofacial prosthetics, and a 0-20% coinsurance for periodontics and oral and maxillofacial surgery.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Choice Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with varying coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Blue Cross Medicare Advantage Choice Premier (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, and outpatient X-ray services. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $100, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Choice Premier (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 not covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 60-100, but there is a $214 copay for days 21-59. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered for this plan. The plan does not cover acupuncture, over-the-counter items, 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.
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