A non-government entity
Blue Cross Medicare Advantage Dental Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dental 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 Dental Premier (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dental Premier (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in NM Enhanced Dental 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 Dental 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 Dental 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 Dental 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 $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:
Sign up for Blue Cross Medicare Advantage Dental Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Cross Medicare Advantage Dental Premier (PPO) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs require a copay starting at $5, while Tier 2 drugs start at a $6 copay 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 16% or 18% coinsurance, while Tier 4 non-preferred drugs carry a 30% or 32% coinsurance depending on your pharmacy choice. Specialty drugs in Tier 5 have a 25% coinsurance for a one-month supply at both preferred and standard locations.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers affordable healthcare coverage with no copay for primary care, telehealth, and preventive services. Specialist visits require a $30 copay, while emergency room visits carry a $115 copay and inpatient hospital stays require a $360 daily copay for the first six days. Outpatient hospital visits have a $400 copay, but diagnostic lab services and outpatient X-rays are available with no copay. Supplemental coverage includes no copay for routine dental, vision, and hearing exams, with comprehensive dental covered up to a $3,000 annual maximum with 0% to 20% coinsurance. Members also benefit from no copay for home health care, the first 20 days of skilled nursing facility care, and a $105 quarterly over-the-counter allowance. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dental Premier (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $360 daily copay for days 1 to 6 of acute stays and a $290 daily copay for days 1 to 6 of psychiatric stays, followed by no copay for days 7 to 90. While unlimited additional acute days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers outpatient hospital and observation services with a $400 copay and no coinsurance, and ambulatory surgical center services with a $395 copay and no coinsurance. Outpatient substance abuse services require a $75 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers ground ambulance services with a $250 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers emergency services with a $115 copay (waived if admitted within three days) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Therapy, mental health, and psychiatric services have copays ranging from $35 to $40 with no coinsurance, though podiatry is not covered, and chiropractic care covers some services but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, fitness benefits, and remote access technologies. However, this benefit is only partially covered, as health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) with no deductible and no coinsurance, featuring a $40 copay for Medicare-covered exams and no copay for routine exams and fittings. Prescription hearing aids are partially covered with a $699 to $999 copay for up to two devices 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 Dental Premier (PPO) offers partially covered vision services with no copay and no coinsurance for routine eye exams and eyewear like contact lenses, eyeglass lenses, and eyeglass frames. However, other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) provides partially covered dental services with a $35 copay and no coinsurance for Medicare-covered services, and no copay or coinsurance for routine exams, cleanings, and x-rays. Comprehensive dental services feature no copay and 0% to 20% coinsurance up to a $3,000 annual maximum, though other diagnostic services, fluoride treatment, other preventive services, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Dental Premier (PPO) with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other infusion drugs require no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Dental Premier (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Members pay no copay for lab services and outpatient X-rays, while diagnostic procedures have a copay of $0 to $100 and therapeutic radiological services require a minimum copay of $60.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) with no coinsurance and require prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Blue Cross Medicare Advantage Dental Premier (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 60 to 100, a $218 daily copay for days 21 to 59, and additional days beyond the 100-day limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $105 limit every three months that carries forward if unused. Acupuncture, meal benefits, and naloxone are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved