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Blue Medicare PPO Enhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare PPO Enhanced (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare PPO Enhanced (PPO) in 2026, please refer to our full plan details page.
Blue Medicare PPO Enhanced (PPO) is a PPO plan offered by CuraCor Solutions Corp. available for enrollment in 2025 to people living in Select North Carolina Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Blue Medicare PPO Enhanced (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 Blue Medicare PPO Enhanced (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 Blue Medicare PPO Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $100.00 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:
Sign up for Blue Medicare PPO Enhanced (PPO)
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Drug Coverage
The Blue Medicare PPO Enhanced (PPO) plan features a low $100 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs when using preferred pharmacies or preferred mail-order services. Tier 2 generic medications are also highly affordable, requiring no copay for preferred mail order and only a $4 copay for a one-month supply at preferred pharmacies. For higher-tier medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 31% coinsurance across all pharmacy options. Standard pharmacies and standard mail-order services are also available, though they generally feature higher copays for generic prescriptions.
Additional Benefits
The Blue Medicare PPO Enhanced (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits, annual physicals, and home health services. Specialist visits require a low $20 copay, while emergency care has a $130 copay that is waived if you are admitted. For hospital stays, members pay a $350 daily copay for the first few days of inpatient care and no copay for subsequent days, all with no coinsurance. This plan also includes valuable extra benefits like routine dental and vision care with no copay, featuring a $2,000 annual dental limit and a $300 vision allowance. Routine hearing exams are covered with no copay, and prescription hearing aids are available with copays starting at $499. Additionally, members benefit from a $40 quarterly allowance for over-the-counter items and up to 12 one-way trips to health-related locations per year with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Blue Medicare PPO Enhanced (PPO) with no coinsurance, requiring prior authorization and a daily copay of $350 for the first 6 days of acute stays and the first 5 days of psychiatric stays, followed by no copay for subsequent days. While unlimited additional acute days are covered at no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Blue Medicare PPO Enhanced (PPO) with no coinsurance, featuring a $0 to $335 copay for outpatient hospital services and a $335 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copays or coinsurance, while outpatient substance abuse individual and group sessions require a $20 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by the Blue Medicare PPO Enhanced (PPO) plan with a $60.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Blue Medicare PPO Enhanced (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to any health-related location, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Blue Medicare PPO Enhanced (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 48 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency services are covered up to $100,000 with no coinsurance and copays ranging from $50 to $250.
Primary Care See details
Blue Medicare PPO Enhanced (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Therapy, mental health, and telehealth services are covered with copays ranging from $0 to $20 and no coinsurance, while chiropractic services are partially covered (routine chiropractic is not covered) and podiatry is not covered.
Preventive Services See details
Preventive services are covered by Blue Medicare PPO Enhanced (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, and select screenings. Some additional preventive benefits are partially covered, but sub-services such as health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Blue Medicare PPO Enhanced (PPO), which offers routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Medicare PPO Enhanced (PPO) covers vision services with no deductible and an annual maximum benefit of $300. Routine eye exams and eyeglasses have no copay and no coinsurance, while contact lens exams require a $20 copay and contact lenses are subject to a 20% coinsurance.
Dental Services See details
Blue Medicare PPO Enhanced (PPO) offers partially covered dental services, requiring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 annual maximum. Non-covered sub-services include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Blue Medicare PPO Enhanced (PPO) covers home infusion bundled services with no copay, although prior authorization and step therapy may apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Medicare PPO Enhanced (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare PPO Enhanced (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic shoes, with no copay and 20% coinsurance. Diabetic supplies are also covered with no copay and coinsurance ranging from no coinsurance to 20%, subject to prior authorization and manufacturer limitations.
Diagnostic and Radiological Services See details
Blue Medicare PPO Enhanced (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic tests with a copay ranging from $0 to $25. Radiological services require prior authorization and carry a minimum 20% coinsurance and a $0 minimum copay for diagnostic and therapeutic imaging, while outpatient X-ray services have no copay and require coinsurance.
Home Health Services See details
Blue Medicare PPO Enhanced (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Medicare PPO Enhanced (PPO) with no coinsurance and no copay, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Medicare PPO Enhanced (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay but subject to prior authorization. Under this plan, you pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per stay, with no coverage for additional days beyond the Medicare limit.
Other Services See details
Blue Medicare PPO Enhanced (PPO) partially covers other services, offering no copay and no coinsurance for over-the-counter (OTC) items and chronic illness meal benefits, while acupuncture is not covered. Eligible members receive a $40 quarterly allowance for OTC items and referral-based meal benefits at no cost.
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