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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 2026, 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 NM Defined 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 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 a $450.00 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 $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:
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Drug Coverage
The Blue Cross Medicare Advantage Choice Premier (PPO) plan features an annual drug deductible of $450. For generic prescriptions, members can save significantly by using preferred pharmacies or preferred mail-order services, which offer no copay for Tier 1 preferred generics and low copays starting at $1 for Tier 2 generics. Standard pharmacies and standard mail-order options are also available with slightly higher copays, such as $5 for Tier 1 and $6 for Tier 2 prescriptions. For higher-tier medications, the plan uses coinsurance rather than set copays, with Tier 3 preferred brands requiring 17% coinsurance at preferred locations and 19% at standard locations. Tier 4 non-preferred drugs carry a 35% coinsurance at preferred pharmacies and 38% at standard pharmacies, while Tier 5 specialty drugs require a flat 27% coinsurance across all pharmacy options for a one-month supply. Choosing preferred network pharmacies and mail-order services helps policyholders minimize their out-of-pocket prescription costs under this plan.
Additional Benefits
The Blue Cross Medicare Advantage Choice Premier (PPO) plan offers robust medical coverage with predictable costs, featuring no copays for primary care visits, telehealth, and preventive services. For specialized care, members pay a $25 copay for specialists, a $125 copay for emergency room visits, and a $375 copay for outpatient hospital services, all with no coinsurance. Inpatient hospital stays require a daily copay of $340 for the first nine days of acute care and no copay for subsequent days. This PPO plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copays or coinsurance. Members receive up to $100 annually for eyewear and a quarterly $50 over-the-counter allowance for health items with no copay. Prescription hearing aids are covered with no coinsurance and copays ranging from $699 to $999, ensuring comprehensive coverage for essential daily needs.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers inpatient hospital services with no coinsurance, requiring a $340 daily copay for days 1 to 9 of acute stays and a $265 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent days. Additional acute days are covered with no copay, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) outpatient services are covered with no coinsurance, featuring a $375 copay for outpatient hospital and observation services, and a $325 copay for ambulatory surgical center services. Outpatient substance abuse sessions have a $75 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with no copay and a 20% coinsurance, both requiring prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers emergency services with a $125 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers primary care and telehealth visits with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Mental health services ($30 copay), physical, occupational, and speech therapies ($40 copay), and opioid treatment ($45 copay) all require no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no copay and no coinsurance for annual physical exams, fitness benefits, remote access technologies, kidney education, and screenings. This benefit is partially covered as it excludes health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and safety devices.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Choice Premier (PPO), offering Medicare-covered exams for a $40 copay and no coinsurance, alongside routine exams and fitting evaluations for no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $699 to $999, 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 Premier (PPO) features partially covered vision services with no copay and no coinsurance for routine eye exams and select eyewear, including contact lenses, frames, and lenses up to a $100 annual limit. Other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by the Blue Cross Medicare Advantage Choice Premier (PPO), which features a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for annual exams, cleanings, and X-rays. Non-covered services include fluoride, restorative, endodontics, periodontics, prosthodontics, implants, and orthodontics.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers medical equipment with no copay, though prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays require no copay, while diagnostic procedures range from a $0 to $100 copay, diagnostic radiology starts at a $0 copay, and therapeutic radiology starts at a $45 copay.
Home Health Services See details
Home Health Services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the Blue Cross Medicare Advantage Choice Premier (PPO), though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered under the Blue Cross Medicare Advantage Choice Premier (PPO) with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20 and days 50 through 100, but a $218 daily copay applies for days 21 through 49, with prior authorization required.
Other Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $50 limit every three months that rolls over if unused. Acupuncture, meal benefits, and naloxone are not covered under this benefit.
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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.
* 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.
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