Medicare PPO Blue EssentialRx (PPO)

Medicare PPO Blue EssentialRx (PPO) is a PPO plan offered by Blue Cross and Blue Shield of Massachusetts, Inc. available for enrollment in 2026 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 EssentialRx (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 EssentialRx (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.

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:

Drug Coverage

The Medicare PPO Blue EssentialRx (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs are available with a $10 copay for a one-month supply at preferred pharmacies and standard mail order, or a $20 copay at standard pharmacies. For higher-tier medications, the plan transitions from flat copays to a percentage-based cost-sharing model. Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance across preferred pharmacies, standard pharmacies, and standard mail order. While Tier 3 and Tier 4 drug coinsurance applies to up to a three-month supply, Tier 5 specialty drugs are limited to a one-month supply.

Additional Benefits

The Medicare PPO Blue EssentialRx (PPO) plan offers robust coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, members can expect a copay ranging from no copay up to $55, while emergency room visits incur a $115 copay that is waived if admitted. Inpatient hospital stays require a daily copay of $388 for the first seven days of acute care, after which there is no copay, and outpatient services carry a 30% coinsurance with no copay. Supplemental benefits under this plan include routine hearing and dental exams with no copay, alongside diagnostic dental coverage up to a $500 annual limit. Vision services feature an annual routine eye exam with a copay of up to $55 and a $200 allowance for eyewear every two years. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, helping members manage their ongoing healthcare costs predictably.