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Blue Cross Medicare Advantage Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Access (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 Access (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Access (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in NM Plan G Look a Like 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 Access (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 Access (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 Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $135.00. 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 $5700.00 (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 $5700.00 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 Access (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays for these generic tiers range from $5 to $18 depending on the supply duration. Tier 3 preferred brand drugs require a 16% coinsurance at preferred locations and 20% at standard locations, while Tier 4 non-preferred drugs carry a 36% or 40% coinsurance respectively. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Access (PPO) plan offers comprehensive coverage for core medical needs, featuring no copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and home health care. Preventive services, routine eye exams, and routine hearing exams are also available with no copay, making it easy to maintain your health. For specialized services, members will encounter predictable cost-sharing, such as a $130 copay for emergency care and up to a $350 copay for outpatient hospital visits. Additionally, medical equipment and dialysis require a 20% coinsurance, while routine dental services, eyewear, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Blue Cross Medicare Advantage Access (PPO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered because non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Access (PPO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital services, a $300 copay for ambulatory surgical center visits, and a $75 copay for outpatient substance abuse sessions. Additionally, there is no copay and no coinsurance for observation services and outpatient blood services.
Partial Hospitalization See details
Blue Cross Medicare Advantage Access (PPO) covers partial hospitalization services with a $100.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Access (PPO) provides partial coverage for ambulance and transportation services, with ground ambulance services requiring a $275 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Routine transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Blue Cross Medicare Advantage Access (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Access (PPO) primary care benefits are partially covered with no copay and no coinsurance for primary care, specialist, therapy, mental health, psychiatric, telehealth, and opioid treatment services. Podiatry services are not covered, and while some chiropractic services are covered, routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Access (PPO) offers partially covered preventive services with no copays and no coinsurance for covered benefits, including fitness benefits, remote access technologies, kidney disease education, and glaucoma screenings. However, some services are not covered under this plan, such as annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing Services are partially covered by Blue Cross Medicare Advantage Access (PPO), featuring routine exams and hearing aid fittings with no copay and no coinsurance. Prescription hearing aids are limited to two per year with no coinsurance and copays ranging from $699 to $999, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Access (PPO) covers one routine eye exam per year with no copay and no coinsurance, up to a $40 maximum annual benefit, though other eye exam services are not covered. Eyewear, including eyeglasses and contact lenses, is not covered under this plan.
Dental Services See details
Blue Cross Medicare Advantage Access (PPO) partially covers dental services, providing Medicare-covered dental services with no copay and no coinsurance. Routine and comprehensive dental services—including oral exams, cleanings, x-rays, fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery—are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Access (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Access (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Access (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copay and required prior authorization. Members will pay a 20% coinsurance for most equipment and supplies, though diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Access (PPO), with prior authorization required for these benefits. Diagnostic procedures, lab services, and diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a 20% coinsurance and outpatient X-rays carry a $125 copay and coinsurance.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Access (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Access (PPO) covers some cardiac rehabilitation services with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Access (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Access (PPO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Because these services are not covered by the plan, there are no associated copays or coinsurance options available.
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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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