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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 New Mexico. 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 $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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $9500.00 (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 $9500.00 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 an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Choice Premier (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services like primary care, preventive services, and some mental health services have no copay. The plan also covers hearing, vision, and dental services with different cost structures, including copays for exams and varying coinsurance for other services. Additional benefits include coverage for ambulance, emergency services, and home health services with specific copays or coinsurance. The plan also provides coverage for services like home infusion, dialysis, medical equipment, and diagnostic services, each with its own cost-sharing structure. Additionally, the plan offers over-the-counter (OTC) benefits and covers skilled nursing facilities with no copay for some days.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare plans, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-9, and no copay for days 10-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $265 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, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan. Outpatient Hospital Services have a $325 copay, Observation Services have a $295 copay, Ambulatory Surgical Center (ASC) Services have a $250 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $75 copay. Outpatient Blood Services have no copay.
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
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; however, 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 have a $125 copay, and Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Choice Premier (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while physician specialist services have a $25 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and Opioid Treatment Program Services have a $45 copay. Additional Telehealth Benefits have no copay. Routine Chiropractic Care and Podiatry services are not covered.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services are covered, including Fitness Benefit and Remote Access Technologies, with no copay. Other services, like Health Education, are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $699 and $999. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay. Eyewear has no copay, and contact lenses, eyeglass lenses, and eyeglass frames are covered, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay. Other Dental Services include oral exams, dental x-rays, and prophylaxis (cleaning), all with no copay, as well as 2 free oral exams and cleanings and 1 free dental x-ray per year. Restorative Services have no coinsurance, while Adjunctive General Services and Oral and Maxillofacial Surgery have 50% and 20% coinsurance, respectively; Periodontics has 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, you will pay a $35 copay, and the coinsurance can range from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan, but require prior authorization. You will be responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Blue Cross Medicare Advantage Choice Premier (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance with no copay. Diabetic Equipment is covered, and Diabetic Supplies have a 0-20% 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 Premier (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $300, Therapeutic Radiological Services have a $45 copay, and Outpatient X-Ray Services have no copay.
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. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and the copay for covered services is described elsewhere in the plan details.
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. For days 1-20 and 50-100, there is no copay, while days 21-49 have a copay of $214. Additional days beyond Medicare-covered SNF stays, as well as non-Medicare-covered SNF stays, are not covered.
Other Services See details
Other services include coverage for over-the-counter (OTC) items with a maximum benefit coverage amount of $65.00 every three months, and the plan offers Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. Acupuncture, 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 are not covered.
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