A non-government entity
Blue Cross Medicare Advantage Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice Plus (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 Plus (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice Plus (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Dallas/Austin/Houston $0 Low 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 Plus (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 Plus (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 Plus (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 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 $615.00 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 $13900.00 (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 $13900.00 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 Plus (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Cross Medicare Advantage Choice Plus (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing a $1 copay for a one-month fill at preferred locations compared to a $6 copay at standard pharmacies. Brand-name and specialty medications under this plan are covered through coinsurance rather than flat copays. Tier 3 preferred brands require a 17% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 35% coinsurance at preferred locations. Specialty drugs in Tier 5 require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Cross Medicare Advantage Choice Plus (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health care, and routine preventive services. For inpatient hospital stays, members pay a $380 daily copay for days one through six and no copay for additional days, with no coinsurance required. Outpatient hospital services require a $425 copay, while emergency care is available for a $100 copay that is waived upon admission. Routine dental, vision, and hearing exams are also highly accessible with no copay and no coinsurance, although prescription hearing aids require a copay between $699 and $999. Skilled nursing facility care is covered with no copay for days 1 to 20 and days 60 to 100, though days 21 to 59 require a $218 daily copay. Essential medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers inpatient acute hospital stays with no coinsurance and a $380 daily copay for days 1 to 6, with no copay for days 7 and beyond. Inpatient psychiatric care is covered with no coinsurance and a $270 daily copay for days 1 to 6, and no copay for days 7 to 90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers outpatient hospital services with a $425 copay and no coinsurance, and ambulatory surgical center services with a $375 copay and no coinsurance. Outpatient substance abuse services 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 Plus (PPO) covers partial hospitalization with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Blue Cross Medicare Advantage Choice Plus (PPO), with ground ambulance services requiring a $275 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Although transportation is listed as covered, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers emergency services with a $100 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $100 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Physical, occupational, and mental health therapies require copays between $30 and $50 with no coinsurance, though podiatry is not covered and chiropractic services are only partially covered, with routine and other chiropractic services excluded.
Preventive Services See details
Preventive services are partially covered by Blue Cross Medicare Advantage Choice Plus (PPO) with no copay and no coinsurance for exams, fitness benefits, and screenings. However, non-covered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) provides partially covered hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, as well as routine exams and fittings with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a $699 to $999 copay, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) vision services are partially covered with no copay, no coinsurance, and no deductible for routine eye exams, contact lenses, eyeglass lenses, and frames up to specified annual limits. However, other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) provides partially covered dental services, which include Medicare-covered dental care for a $50 copay and no coinsurance. Routine oral exams, cleanings, and x-rays are covered with no copay and no coinsurance, but other services such as fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy apply. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers medical equipment with no copays, although prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $100 copay for diagnostic procedures. Covered radiological services require prior authorization and carry no copay for X-rays and diagnostic radiology, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Blue Cross Medicare Advantage Choice Plus (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 Plus (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, though only some services are covered in practice. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Choice Plus (PPO) with no coinsurance and no prior three-day hospital stay required. Under this plan, there is no copay for days 1 to 20 and days 60 to 100, a $218 daily copay for days 21 to 59, and prior authorization is required.
Other Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) provides coverage for some services under its Other Services benefit, although acupuncture, Over-the-Counter (OTC) items, and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved