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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 2025, 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 San Antonio Metro Area. 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 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 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 $14000.00 (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 $14000.00 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)
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Drug Coverage
The Blue Cross Medicare Advantage Choice Plus (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $10 copay at a preferred pharmacy, and $20 at a standard pharmacy. For preferred brand drugs, you will pay 50% coinsurance, regardless of the pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Choice Plus (PPO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay for the rest. Outpatient services have copays depending on the service, and emergency services and primary care visits also have copays. Preventive services, including annual physical exams, have no copay, while hearing and vision services include exams and eyewear with no copay. Dental services cover oral exams, x-rays, and cleaning with no copay, and some restorative services have coinsurance. The plan also covers home health services and skilled nursing facility stays with no copay for some days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $390 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $270 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, include a $350 copay for Outpatient Hospital Services and Observation Services, a $275 copay for Ambulatory Surgical Center (ASC) Services, and a $75 copay for both Individual and Group Sessions for Outpatient Substance Abuse. Outpatient Blood Services have a 20% coinsurance, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and all have no coinsurance. Worldwide Urgent Coverage also has a $110 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $34 copay, and Physical Therapy and Speech-Language Pathology Services with a $40 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a $30-$35 copay depending on the service, while Additional Telehealth Benefits have no copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered, but copays may apply.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for these services. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $100. Contact lenses, eyeglass lenses, and eyeglass frames are covered, while eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $50 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Restorative Services and Adjunctive General Services have no coinsurance, while Endodontics, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, and Prosthodontics (fixed) have 20% coinsurance. Orthodontic Services are covered up to $1,000 per year. Fluoride Treatment, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have between 0% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have a $5 copay, Diagnostic Radiological Services have a copay up to $300, and Outpatient X-Ray Services have a $5 copay; Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Choice Plus (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 Plus (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 Plus (PPO) plan, but require prior authorization. For days 1-20 and 60-100, there is no copay, while days 21-59 have a $214 copay.
Other Services See details
The Blue Cross Medicare Advantage Choice Plus (PPO) 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, or Self-Directed Personal Assistance Services. No authorization or referrals are required for these services.
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