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Medicare PPO Blue PlusRx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare PPO Blue PlusRx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare PPO Blue PlusRx (PPO) in 2026, please refer to our full plan details page.
Medicare PPO Blue PlusRx (PPO) is a PPO plan offered by Blue Cross and Blue Shield of Massachusetts, Inc. available for enrollment in 2025 to people living in Massachusetts except Berkshire Dukes and Nantucket. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Medicare PPO Blue PlusRx (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 Medicare PPO Blue PlusRx (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 Medicare PPO Blue PlusRx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $300.00. 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 $200.00 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 $6300.00 (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 $6300.00 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 Medicare PPO Blue PlusRx (PPO) plan features a $200 annual drug deductible. For Tier 1 preferred generic drugs, members pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $6 copay for a one-month supply. Tier 2 generic drugs cost a low $5 copay for a one-month supply at preferred pharmacies and standard mail order, compared to a $10 copay at standard pharmacies. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies and standard mail order, or a $47 copay at standard pharmacies. Non-preferred drugs in Tier 4 carry a $95 copay at preferred pharmacies and standard mail order, rising to a $100 copay at standard pharmacies. For Tier 5 specialty drugs, members are responsible for a 29% coinsurance for a one-month supply across preferred, standard, and standard mail order pharmacies.
Additional Benefits
The Medicare PPO Blue PlusRx (PPO) plan provides comprehensive medical coverage, featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits require a copay ranging from no copay to $40, while inpatient acute hospital stays have a $250 daily copay for the first seven days with no coinsurance. Emergency care and outpatient hospital services are also covered with flat copays of $140 and $150, respectively, and no coinsurance. For supplemental care, this plan offers no copay for routine dental exams, annual hearing evaluations, and routine vision care, alongside a $200 eyewear allowance every two years. Skilled nursing facility stays feature no copay for days 1 through 20 and days 45 through 100, while durable medical equipment is covered with no copay and a 10% coinsurance. Prescription hearing aids are also covered with no coinsurance and a copay ranging from $699 to $999 per aid.
Inpatient Hospital See details
Medicare PPO Blue PlusRx (PPO) covers inpatient acute hospital stays with no coinsurance and a $250 daily copay for days 1 through 7, and inpatient psychiatric stays with no coinsurance and a $125 daily copay for days 1 through 5. Both services require prior authorization and offer unlimited additional days with no copay, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare PPO Blue PlusRx (PPO) covers outpatient services with no coinsurance, featuring a $150 copay for outpatient hospital services and a $100 copay for ambulatory surgical center services. Outpatient substance abuse sessions have a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Medicare PPO Blue PlusRx (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Medicare PPO Blue PlusRx (PPO) covers ground and air ambulance services with a $200 copay (waived if admitted) and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Medicare PPO Blue PlusRx (PPO) covers emergency services with a $140 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no coinsurance and a copay ranging from no copay to $45, while worldwide emergency, urgent, and transportation services are covered with a $75 copay and no coinsurance.
Primary Care See details
Medicare PPO Blue PlusRx (PPO) covers primary care physician and opioid treatment services with no copay and no coinsurance, while specialist visits cost a $0 to $40 copay and no coinsurance. Therapy services, including physical, occupational, and speech, require a $20 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Medicare PPO Blue PlusRx (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes self-management. Covered supplemental benefits include memory fitness, weight management, and chemotherapy wigs, while non-covered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, and re-admission prevention. Additionally, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Medicare PPO Blue PlusRx (PPO) offers partially covered hearing services with no deductible, featuring one annual routine exam and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no coinsurance and a copay of $699 to $999 for up to two aids per year, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Medicare PPO Blue PlusRx (PPO) partially covers vision services with no deductibles, featuring routine eye exams for a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear, including glasses and contact lenses, is covered with no copay and no coinsurance up to a $200 combined limit every two years, but upgrades are not covered.
Dental Services See details
Medicare PPO Blue PlusRx (PPO) offers partially covered dental services, featuring Medicare-covered dental care for a $40 copay and no coinsurance, alongside routine exams, cleanings, and x-rays with no copay and no coinsurance. However, several services are not covered, including fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Medicare PPO Blue PlusRx (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 10% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 10% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Medicare PPO Blue PlusRx (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare PPO Blue PlusRx (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 10% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, but this benefit is only partially covered as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Medicare PPO Blue PlusRx (PPO) with no coinsurance, though prior authorization is required. Covered services include lab services with no copay, outpatient x-rays for a $10 copay, diagnostic tests for a $0 to $10 copay, and diagnostic radiological services with a minimum $150 copay, while therapeutic radiological services are not covered.
Home Health Services See details
Home health services are covered under the Medicare PPO Blue PlusRx (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare PPO Blue PlusRx (PPO) covers cardiac rehabilitation services with no coinsurance and a $15 copayment per session. This coverage includes intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Medicare PPO Blue PlusRx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 45 to 100, a $100 copay for days 21 to 44, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medicare PPO Blue PlusRx (PPO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered.
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