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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 $53.00. 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) prescription drug plan features an annual drug deductible of $100. For maximum cost savings, Tier 1 preferred generic drugs and Tier 6 select care drugs have no copay when filled at preferred pharmacies or through preferred mail order. Tier 2 generic drugs also feature no copay through preferred mail order, or a low $4 copay for a one-month supply at preferred pharmacies. Higher-tier medications require coinsurance instead of copays under this plan. Tier 3 preferred brand drugs have a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 31% coinsurance. These coinsurance rates remain the same whether you use preferred or standard pharmacies and mail order options.
Additional Benefits
The Blue Medicare PPO Enhanced (PPO) plan offers robust medical coverage with no copay for primary care visits, preventive services, and home health care. For specialist visits, urgent care, and emergency room services, members will pay copays of $30, $50, and $130, respectively, with no coinsurance. Inpatient hospital stays require a $350 daily copay for the first five to six days, after which there is no copay for the remainder of the stay. Additional benefits include routine dental, vision, and hearing exams with no copay, featuring a $2,000 annual dental limit and a $300 eyewear allowance. While diagnostic lab work and medical equipment require no copay, members will pay a 20% coinsurance for dialysis and durable medical equipment. The plan also covers up to 12 one-way transportation trips per year to health-related locations with no copay.
Inpatient Hospital See details
Blue Medicare PPO Enhanced (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for subsequent covered days. Additional days for acute stays are unlimited with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Medicare PPO Enhanced (PPO) covers outpatient services 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 are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay per session.
Partial Hospitalization See details
Partial hospitalization services are covered under the Blue Medicare PPO Enhanced (PPO) plan with a $60.00 copay and no coinsurance. Prior authorization is required to receive these 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, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to any health-related location, though plan-approved health-related location transportation 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 admitted to the hospital within 48 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency services are also covered up to a $100,000 maximum with no coinsurance, featuring copays of $130 for emergency care, $50 for urgent care, and $250 for emergency transportation.
Primary Care See details
Blue Medicare PPO Enhanced (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, mental health, and psychiatric services have a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $10 copay and no coinsurance, whereas podiatry is not covered, and for chiropractic services, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Blue Medicare PPO Enhanced (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney education, and glaucoma screenings. Additional preventive services are partially covered with no copay and no coinsurance, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Blue Medicare PPO Enhanced (PPO) covers hearing services with a $25 copay and no coinsurance for Medicare-covered exams, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a $499 to $999 copay and no coinsurance for up to two devices per year, but OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Blue Medicare PPO Enhanced (PPO) covers vision services with no deductible, featuring routine eye exams with no copay and no coinsurance, and contact lens exams with a $30 copay. Eyewear is covered with no copay, except for contact lenses which require a 20% coinsurance, up to a combined annual maximum benefit of $300.
Dental Services See details
Dental services under the Blue Medicare PPO Enhanced (PPO) are covered with a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $2,000 annual limit. While exams, cleanings, and restorative treatments are covered, some services like implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Blue Medicare PPO Enhanced (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 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 with no copay, subject to prior authorization. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Medicare PPO Enhanced (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $25 copay for diagnostic tests. Radiological services require prior authorization and incur a minimum 20% coinsurance with copays starting at $0, while outpatient X-rays have no copay but require coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue Medicare PPO Enhanced (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Medicare PPO Enhanced (PPO) covers some cardiac rehabilitation services with no copay and no coinsurance. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (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 copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Medicare PPO Enhanced (PPO) partially covers other services, offering over-the-counter (OTC) items up to $30 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and other miscellaneous services are not covered under this benefit.
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