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Capital Blue Cross Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Capital Blue Cross Classic (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Capital Blue Cross Classic (PPO) in 2026, please refer to our full plan details page.
Capital Blue Cross Classic (PPO) is a PPO plan offered by CAPITAL BLUE CROSS available for enrollment in 2025 to people living in Central Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Capital Blue Cross Classic (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 Capital Blue Cross Classic (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 Capital Blue Cross Classic (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.00. 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 $6700.00 (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 $6700.00 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 Capital Blue Cross Classic (PPO)
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Drug Coverage
The Capital Blue Cross Classic (PPO) prescription drug plan features a low $100 annual drug deductible. You will enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or preferred mail-order service. For standard pharmacies and standard mail-order options, a one-month supply costs a $10 copay for Tier 1 and a $15 copay for Tier 2. Tier 3 preferred brand-name drugs have a consistent $47 copay for a one-month supply across all pharmacy and mail-order options. If you require higher-tier medications, Tier 4 non-preferred drugs have a 44% coinsurance, while Tier 5 specialty drugs carry a 31% coinsurance for a one-month supply. These structured costs allow you to plan your healthcare expenses with clear copayments and coinsurance rates.
Additional Benefits
The Capital Blue Cross Classic (PPO) plan offers comprehensive coverage with no copays for primary care visits, annual physicals, and home health services. Specialist visits require a $25 copay, while inpatient hospital stays cost a $250 daily copay for the first five days and no copay for days six through ninety. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care is available for a $40 copay. For auxiliary care, the plan features no copays for routine vision exams and preventive dental care, alongside a $2,000 annual dental limit. Hearing exams require a $25 copay, and prescription hearing aids are available with copays ranging from $499 to $999. Diagnostic lab services and home infusions have no copays, while medical equipment and dialysis generally require a 20% coinsurance.
Inpatient Hospital See details
Capital Blue Cross Classic (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $250 copay per day for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. While unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Capital Blue Cross Classic (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $375 copay and observation services at a $240 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Capital Blue Cross Classic (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Capital Blue Cross Classic (PPO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services for a $250 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Capital Blue Cross Classic (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgent care with a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $20,000 limit with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Capital Blue Cross Classic (PPO) covers primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits, therapy, and psychiatric services require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine care, whereas telehealth services carry a $0 to $30 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
Capital Blue Cross Classic (PPO) preventive services are partially covered, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. While benefits like medical nutrition therapy and memory fitness are also covered at no cost, other supplemental services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing Services are covered by Capital Blue Cross Classic (PPO) with no deductible, featuring a $25 copay and no coinsurance for routine hearing exams. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999—excluding inner ear, outer ear, and over-the-ear types—while OTC hearing aids are covered with a $499 copay and no coinsurance.
Vision Services See details
Capital Blue Cross Classic (PPO) offers partially covered vision services with no deductible and no coinsurance. Routine eye exams are covered with no copay (one per year), while eyewear has no copay up to a $175 annual limit for one pair of eyeglasses or contact lenses, though other eye exams, separate frames, separate lenses, and upgrades are not covered.
Dental Services See details
Capital Blue Cross Classic (PPO) offers partially covered dental services up to a $2,000 annual limit, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care like cleanings and oral exams. Covered comprehensive options like restorative, endodontic, and periodontic services require no copay and 50% coinsurance, while other preventive services, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Capital Blue Cross Classic (PPO) with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Capital Blue Cross Classic (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Capital Blue Cross Classic (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required. A 20% coinsurance applies to most equipment and devices, while diabetic supplies carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Capital Blue Cross Classic (PPO), featuring no copay or coinsurance for lab services, diagnostic procedures, and diagnostic radiology. Outpatient x-rays require a $15 copay, and therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization required for these diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by Capital Blue Cross Classic (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Capital Blue Cross Classic (PPO) provides cardiac rehabilitation services with no copay and no coinsurance. While some services are covered, standard 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
Capital Blue Cross Classic (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $5 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, no prior three-day inpatient hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Capital Blue Cross Classic (PPO) partially covers other services, excluding acupuncture and meal benefits. Over-the-counter (OTC) items are covered with no copay and no coinsurance, up to a maximum benefit of $45 every three months.
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