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Medicare PPO Blue SaverRx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare PPO Blue SaverRx (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 SaverRx (PPO) in 2025, please refer to our full plan details page.
Medicare PPO Blue SaverRx (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 3.5 out of 5 stars in 2025.
It's important to know that Medicare PPO Blue SaverRx (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 SaverRx (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 SaverRx (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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 SaverRx (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, the copay is $10 at preferred pharmacies and $20 at standard pharmacies, while it is $10 for mail order. For standard generic drugs, the coinsurance is 24% at any pharmacy. For preferred brand drugs and non-preferred drugs, the coinsurance is 49% and 33% respectively. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Medicare PPO Blue SaverRx (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services like primary care, emergency services, and vision exams often have copays, but the plan covers a wide variety of services. This plan includes coverage for preventive services with no copay for some services, plus hearing, vision, and dental benefits. Additionally, the plan covers ambulance services, home health, and skilled nursing facilities, but with copays or coinsurance for certain services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $385 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-5, and no copay for days 6-90. Additional days for both are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $275 copay, observation services with a $325 copay, ambulatory surgical center (ASC) services with a $200 copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare PPO Blue SaverRx (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare PPO Blue SaverRx (PPO) plan. All Ambulance Services require prior authorization, with no coinsurance, and a $375 copay for both ground and air ambulance services; this copay is waived if admitted to the hospital. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Medicare PPO Blue SaverRx (PPO). Emergency Services have a $95 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $55 and no coinsurance, and Worldwide Emergency Services have a $90 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, while Routine Chiropractic Care is not covered. Occupational Therapy Services have a $20 copay. Physician Specialist Services and Additional Telehealth Benefits have a copay between $0 and $45. Individual Sessions for Mental Health Specialty Services have a copay between $0 and $30, while Group Sessions have a $30 copay. Individual Sessions for Psychiatric Services have a copay between $30, while Group Sessions have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Podiatry Services are not covered. Other Health Care Professional services have a copay between $0 and $45.
Preventive Services See details
The Medicare PPO Blue SaverRx (PPO) plan covers preventive services, including Medicare-covered services with prior authorization, annual physical exams, health education, wigs for hair loss related to chemotherapy (up to $500 per year), weight management programs (up to $250 per year), fitness benefits, enhanced disease management, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have no copay, and routine hearing exams are covered once per year with no copay. Prescription hearing aids are covered, with a copay between $699 and $999 for prescription hearing aids of all types, but inner ear, outer ear, and over-the-ear aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $45, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered. This plan offers a combined maximum benefit of $200 every two years for eyewear, but upgrades are not covered.
Dental Services See details
The Medicare PPO Blue SaverRx (PPO) plan covers dental services, including a $45 copay for Medicare dental services. Other dental services have a $1,500 annual maximum benefit, with a $45 copay for oral exams, and a 50% coinsurance for restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medicare PPO Blue SaverRx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Equipment requires prior authorization. Durable Medical Equipment for use outside the home, and Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $365, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Medicare PPO Blue SaverRx (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare PPO Blue SaverRx (PPO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $170.00. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Medicare PPO Blue SaverRx (PPO) plan's Other Services benefit covers over-the-counter items with a maximum benefit of $55 every three months, and a meal benefit for chronic illnesses. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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