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Blue Cross Medicare Advantage Health Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Health Choice (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 Health Choice (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Health Choice (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in NM Flex Card 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 Health Choice (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 Health Choice (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 Health Choice (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 $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 $10100.00 (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 $10100.00 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 Health Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Health Choice (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using preferred pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order services are used, Tier 1 copays start at $5 and Tier 2 copays start at $6 for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 15% coinsurance at preferred pharmacies and 17% at standard pharmacies, while Tier 4 non-preferred drugs require 35% coinsurance at preferred pharmacies and 39% at standard locations. Tier 5 specialty drugs have a 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Health Choice (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care and telehealth visits. Specialist visits require a $36 copay, while emergency room care is available for a $120 copay, both with no coinsurance. For hospital stays, members pay a daily copay of $370 for the first eight days of acute inpatient care and a $375 copay for outpatient hospital services, with no coinsurance required. This plan also includes valuable everyday wellness benefits, such as preventive dental services, routine hearing exams, and annual physicals with no copay and no coinsurance. Members receive up to $100 annually for eyewear and can purchase covered prescription hearing aids with a $699 to $999 copay. Additionally, the plan covers over-the-counter health items with no copay up to an $85 allowance every three months.
Inpatient Hospital See details
Blue Cross Medicare Advantage Health Choice (PPO) provides inpatient hospital coverage with no coinsurance, requiring a $370 daily copay for days 1 to 8 of acute stays and a $290 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required for these services, and certain benefits such as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers outpatient hospital services with a $375 copay, observation services with a $370 copay per stay, and ambulatory surgical center services with a $300 copay, all with no coinsurance. Outpatient substance abuse services require a $75 copay per session with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Blue Cross Medicare Advantage Health Choice (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers ground ambulance services for a $250 copay with no coinsurance, and air ambulance services for a 20% coinsurance with no copay, with prior authorization required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers emergency services with a $120 copay (waived if admitted within three days) and urgent care with a $40 copay, both featuring no coinsurance. Worldwide emergency and urgent care are partially covered with a $120 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Health Choice (PPO) features primary care and telehealth visits with no copay and no coinsurance, while specialist visits require a $36 copay and no coinsurance. Physical, occupational, and speech therapies require a $50 copay and no coinsurance, mental health services carry a $40 copay with no coinsurance, and podiatry is not covered. Additionally, some chiropractic services are covered for a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Health Choice (PPO) offers partially covered preventive services with no copay and no coinsurance for covered services such as annual physical exams, fitness benefits, remote access technologies, kidney education, glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers hearing services with no coinsurance, featuring no copay for annual routine exams and fitting evaluations, and a $40 copay for Medicare-covered exams. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Health Choice (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered benefits. Routine eye exams are covered up to $40 annually, and contact lenses, eyeglass lenses, and frames are covered up to a combined $100 yearly limit, while other eye exams, upgrades, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered by Blue Cross Medicare Advantage Health Choice (PPO), offering Medicare-covered dental services for a $35.00 copay and no coinsurance, and select preventive services—including two oral exams, one X-ray, and two cleanings per year—with no copay and no coinsurance. Other diagnostic, fluoride, restorative, endodontic, periodontic, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Health Choice (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and coinsurance ranging from no coinsurance to 20%, subject to manufacturer limitations and prior authorization requirements.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have a copay of $0 to $100, diagnostic radiological services start at a $0 copay, and therapeutic radiological services start at a $60 copay.
Home Health Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Health Choice (PPO) provides Cardiac Rehabilitation Services with no coinsurance, and prior authorization is required. While some services are covered, in practice, cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $15 copay), and SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no coinsurance, requiring no copay for days 1 to 20 and days 50 to 100, and a $218 daily copay for days 21 to 49. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Blue Cross Medicare Advantage Health Choice (PPO) offers partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $85 every three months. Acupuncture and meal benefits are not covered under this plan.
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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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