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Platinum Blue Choice Plan with Rx (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Platinum Blue Choice Plan with Rx (Cost). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Platinum Blue Choice Plan with Rx (Cost) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Platinum Blue Choice Plan with Rx (Cost) is a Cost plan offered by BCBSM, Inc. available for the 2026 plan year to people living in 21 County Region. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Platinum Blue Choice Plan with Rx (Cost) 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 Platinum Blue Choice Plan with Rx (Cost).
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 Platinum Blue Choice Plan with Rx (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $227.00. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $3900.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Platinum Blue Choice Plan with Rx (Cost)
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Drug Coverage
The Platinum Blue Choice Plan with Rx (Cost) features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard pharmacies or preferred mail order services for up to a three-month supply. If you choose standard mail order, Tier 1 drugs have a copay of $5 to $10, while Tier 2 drugs carry a copay of $15 to $30 depending on the supply length. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require 23% to 24% coinsurance, and Tier 4 non-preferred drugs require 44% to 46% coinsurance, with the lower rates available through standard pharmacies and preferred mail order. Tier 5 specialty drugs require a flat 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Platinum Blue Choice Plan with Rx (Cost) offers robust coverage for essential medical services, often with no coinsurance. Primary care visits and preventive services are available with no copay, while specialist visits require a $20 copay. Inpatient hospital stays have a $350 copay per admission, and emergency room visits feature a $100 copay that is waived if you are admitted. For specialty care, the plan provides routine vision and hearing exams with no copay, alongside preventive dental care with no copay up to a $1,000 annual limit. Skilled nursing facility stays feature no copay for the first 20 days, and members receive up to $50 every three months for over-the-counter items with no copay. Additionally, home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
The Platinum Blue Choice Plan with Rx (Cost) covers inpatient acute and psychiatric hospital stays with a $350 copay per admission and no coinsurance. This benefit is partially covered, as unlimited additional days are provided at no copay for acute stays, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Platinum Blue Choice Plan with Rx (Cost) with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services, a $150 copay per stay for observation services, and a $50 copay for ambulatory surgical center services. Outpatient blood services have no copay or coinsurance, but outpatient substance abuse services are not covered in practice as both individual and group sessions are excluded.
Partial Hospitalization See details
Platinum Blue Choice Plan with Rx (Cost) covers partial hospitalization services with a $15.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Platinum Blue Choice Plan with Rx (Cost) partially covers ambulance and transportation services, offering Medicare-covered ground and air ambulance services for a $300 copay and no coinsurance. However, transportation services to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Platinum Blue Choice Plan with Rx (Cost) covers emergency services with a $100 copay (waived if admitted within 24 hours) and no coinsurance, and urgent care with a $15 copay and no coinsurance. Worldwide emergency services are partially covered with no coinsurance, offering worldwide emergency care and transportation for a $100 copay each, while worldwide urgent coverage is not covered.
Primary Care See details
Platinum Blue Choice Plan with Rx (Cost) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Physical, occupational, and speech therapies require a $15 copay and no coinsurance, while podiatry and telehealth are not covered. Chiropractic services are partially covered with a $15 copay and no coinsurance (excluding routine and other chiropractic), and mental health and psychiatric services are partially covered with no copay and no coinsurance (excluding individual and group sessions).
Preventive Services See details
Preventive services are covered by the Platinum Blue Choice Plan with Rx (Cost) with no copay and no coinsurance, including annual physicals, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, as in-home safety assessments, personal emergency response systems, 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, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by the Platinum Blue Choice Plan with Rx (Cost), offering routine exams with no copay and no coinsurance. Covered prescription hearing aids have no coinsurance and a copay ranging from $599 to $899, but OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription models, are not covered.
Vision Services See details
Platinum Blue Choice Plan with Rx (Cost) offers partially covered vision services, including one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay and a 20% coinsurance for contact lenses up to a $125 annual limit, but eyewear upgrades are not covered.
Dental Services See details
Platinum Blue Choice Plan with Rx (Cost) provides partially covered dental services up to a $1,000 annual maximum, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive care like exams, cleanings, x-rays, and periodontics. Non-covered dental services under this plan include restorative, endodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Platinum Blue Choice Plan with Rx (Cost) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a copay of $0 to $35 and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Platinum Blue Choice Plan with Rx (Cost) with no copay and a 20% coinsurance.
Medical Equipment See details
Platinum Blue Choice Plan with Rx (Cost) covers medical equipment with no copays, offering durable medical equipment with a 20% to 40% coinsurance and prosthetics, medical supplies, and diabetic therapeutic shoes with a 20% coinsurance. While diabetic therapeutic shoes are covered, diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Platinum Blue Choice Plan with Rx (Cost) covers diagnostic and radiological services with no copay and no coinsurance. While some services are covered, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Platinum Blue Choice Plan with Rx (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Platinum Blue Choice Plan with Rx (Cost) because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded, despite a technical listing of no copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Platinum Blue Choice Plan with Rx (Cost) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a three-day prior inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Platinum Blue Choice Plan with Rx (Cost) partially covers other services, excluding meal benefits. Covered benefits include acupuncture with a $15 copay and no coinsurance for up to 12 treatments yearly, additional telehealth with no copay to a $20 copay and no coinsurance, and over-the-counter items with no copay and no coinsurance up to $50 every three months.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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