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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 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 Mid South Texas $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:
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Drug Coverage
The Blue Cross Medicare Advantage Choice Plus (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service, while standard locations charge a $5 copay for a one-month supply. Tier 2 generic medications are also highly affordable, costing as little as a $1 copay for a one-month supply at preferred pharmacies. For higher-tier prescription medications, cost sharing transitions to a percentage of the drug cost. Tier 3 preferred brand drugs require 19% coinsurance at preferred pharmacies and 21% at standard pharmacies, while Tier 4 non-preferred drugs range from 34% to 37% coinsurance. Tier 5 specialty drugs require 25% coinsurance for a one-month supply across both preferred and standard pharmacy networks.
Additional Benefits
Blue Cross Medicare Advantage Choice Plus (PPO) offers comprehensive medical coverage with no copay for preventive services, telehealth, and home health care. For routine medical care, you will pay a $10 copay for primary care visits and a $43 copay for specialists, both with no coinsurance. Inpatient hospital stays require a daily copay for the first six days followed by no copay, while emergency room visits carry a $110 copay. This plan also includes routine dental, vision, and hearing exams with no copay or coinsurance, though comprehensive dental services are not covered. Prescription hearing aids are partially covered with copays between $699 and $999, while medical equipment and dialysis require a 20% coinsurance. Diagnostic lab tests are highly accessible with a $5 copay and no coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care stays require a $405 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $270 daily copay for days 1 through 6 and no copay for days 7 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers outpatient hospital services with a $395 copay and no coinsurance, and ambulatory surgical center and observation services with a $350 copay and no coinsurance. Outpatient substance abuse sessions require a $75 copay and no coinsurance, while outpatient blood services are covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers partial hospitalization services with a $40.00 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 Plus (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers emergency services with a $110 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are partially covered with a $110 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Choice Plus (PPO) offers primary care physician visits for a $10 copay and specialist visits for a $43 copay, both with no coinsurance. Physical, occupational, and speech therapy services require copays of $35 to $50 with no coinsurance, telehealth has no copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers preventive services—including annual physical exams, fitness benefits, remote access technologies, and kidney disease education—with no copay and no coinsurance. However, these additional benefits are only partially covered, as services such as health education, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services are covered by Blue Cross Medicare Advantage Choice Plus (PPO), featuring routine hearing exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $50 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two devices per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Blue Cross Medicare Advantage Choice Plus (PPO) with no copay, no coinsurance, and no deductible for covered care. This benefit includes one routine eye exam per year (up to $40) and select eyewear like contacts, frames, and lenses (up to a combined $100 yearly), while other eye exam services, combined eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) partially covers dental services, offering Medicare-covered dental care for a $50 copay and no coinsurance, plus select preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered under this plan.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs have 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, although prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copays and a 20% coinsurance (ranging from no coinsurance to 20% for diabetic supplies). Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers diagnostic services with no coinsurance, requiring a $5 copay for lab tests and between no copay and a $100 copay for diagnostic procedures. Radiological services are also covered under the plan, with outpatient X-rays costing a $5 copay plus coinsurance, diagnostic radiology starting at no copay, and therapeutic radiology requiring a copay and a minimum 20% coinsurance. Prior authorization is required for both diagnostic and radiological services.
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 some Cardiac Rehabilitation Services with no copay and no coinsurance, although specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 60 to 100, and a $218 daily copay for days 21 to 59. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers some other services, but specific benefits such as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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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.
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