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Medicare BlueClassic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare BlueClassic (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare BlueClassic (PPO) in 2026, please refer to our full plan details page.
Medicare BlueClassic (PPO) is a PPO plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Greater Syracuse Region. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Medicare BlueClassic (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 BlueClassic (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 BlueClassic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $53.30. 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 $300.00 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 $10950.00 (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 $10950.00 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 BlueClassic (PPO) plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order, while standard options charge a $5 to $10 copay. Tier 2 generic drugs require a $5 copay for a one-month supply at preferred locations, whereas standard pharmacies and mail-order services charge $10. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a 20% coinsurance across all network pharmacies and mail-order services. Tier 4 non-preferred drugs have a 37% coinsurance at preferred locations and a 50% coinsurance at standard locations. Tier 5 specialty tier drugs require a 29% coinsurance regardless of whether you use preferred or standard pharmacies.
Additional Benefits
Medicare BlueClassic (PPO) provides robust healthcare coverage with predictable costs, including a $5 copay for primary care doctor visits and a $35 copay for specialists with no coinsurance. If you require inpatient hospital care, you will pay a $400 daily copay for the first five days and no copay for any additional days. Emergency room visits require a $115 copay, which is waived upon admission, while urgent care services are available for a $40 copay. This plan also features excellent wellness benefits, offering routine annual eye exams and preventive dental services with no copay or coinsurance. Routine hearing exams carry a $35 copay, and home health services are covered with no copay and no coinsurance. Additionally, members can access essential preventive services, such as annual physicals and screenings, at no cost to easily manage their health.
Inpatient Hospital See details
Medicare BlueClassic (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, there is a $400 daily copay for days 1 to 5 and no copay for additional days, while psychiatric care requires a $375 daily copay for days 1 to 5 and no copay for days 6 to 90. Room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Medicare BlueClassic (PPO), with outpatient hospital, observation, and ambulatory surgical center services requiring a $300 copay and no coinsurance. Outpatient substance abuse services feature no copay and a 20% coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Medicare BlueClassic (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Medicare BlueClassic (PPO) covers ground and air ambulance services with a $240 copay and no coinsurance, requiring prior authorization. While transportation services are technically offered, only some services are covered, and transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Medicare BlueClassic (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 23 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $115, $40, and $240 respectively.
Primary Care See details
Medicare BlueClassic (PPO) covers primary care physician visits for a $5 copay and specialist visits for a $35 copay, both with no coinsurance. Physical and occupational therapy require a $30 copay and no coinsurance, while mental health services feature no copay and 20% coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Medicare BlueClassic (PPO) partially covers preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes training. While memory fitness and remote access technologies are covered, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and counseling.
Hearing Services See details
Medicare BlueClassic (PPO) hearing services are partially covered, offering routine hearing exams for a $35 copay and no coinsurance, and prescription hearing aids for a $499 to $799 copay and no coinsurance. OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Medicare BlueClassic (PPO) offers partially covered vision services, which include one routine eye exam per year with no copay or coinsurance, and eyewear with a $35 copay for contact lenses and no coinsurance up to a $100 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Medicare BlueClassic (PPO) partially covers dental services, offering Medicare-covered dental care with a $35 copay and no coinsurance, alongside covered preventive and comprehensive services with no copay or coinsurance up to a $500 annual maximum. Uncovered services under this plan include fluoride treatments, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare BlueClassic (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medicare BlueClassic (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare BlueClassic (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies from specified manufacturers are covered with a $5 copay and no coinsurance, while diabetic therapeutic shoes and inserts require a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medicare BlueClassic (PPO), with diagnostic procedures, tests, and lab services being excluded from coverage. For covered services, diagnostic radiological services require a minimum $200 copay and no coinsurance, therapeutic radiological services require a copay and 20% coinsurance, and outpatient X-rays require a $45 copay and coinsurance.
Home Health Services See details
Home Health Services are covered under Medicare BlueClassic (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Medicare BlueClassic (PPO) with no coinsurance and a $15 copayment for covered services. However, standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Medicare BlueClassic (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond those covered by Medicare are not covered.
Other Services See details
Medicare BlueClassic (PPO) partially covers other services, offering acupuncture with no copay and a 50% coinsurance for up to 10 treatments every year. Over-the-counter (OTC) items and meal benefits are not covered.
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