A non-government entity
BlueJourney Prime (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueJourney Prime (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueJourney Prime (PPO) in 2025, please refer to our full plan details page.
BlueJourney Prime (PPO) is a PPO plan offered by CAPITAL BLUE CROSS available for enrollment in 2025 to people living in 21 Counties in Central PA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BlueJourney Prime (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 BlueJourney Prime (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 BlueJourney Prime (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $168.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6000.00 (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 $6000.00 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 BlueJourney Prime (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueJourney Prime (PPO) plan has an "Enhanced Alternative" drug benefit type and a $0 deductible. In the initial coverage phase, you'll pay a copay for your prescriptions. For preferred generic drugs, the copay is $5 at preferred pharmacies and mail order, and $20 at standard pharmacies. For standard generic drugs, the copay is $47, and for preferred brand drugs, the copay is $100. Non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueJourney Prime (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services can have copays up to $300. Emergency and urgent care have copays, and primary care visits start at a $5 copay. Preventive services, including annual exams, are available with no copay. The plan covers hearing and vision services with copays for exams and hearing aids, and offers dental coverage with copays and coinsurance. Other benefits include ambulance services, home health, and medical equipment, each with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $175 copay for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, while the Additional Days for Inpatient Hospital-Acute benefit has no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and the Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the BlueJourney Prime (PPO) plan. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $225 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services, including both individual and group sessions, have a copay of $25.00. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The BlueJourney Prime (PPO) plan covers ambulance services with a $150 copay for both ground and air ambulance services, with no coinsurance. Transportation services to plan-approved health-related locations are covered for up to 12 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueJourney Prime (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $35 copay, while Worldwide Emergency Coverage has a $125 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueJourney Prime (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, and speech-language pathology services with a $25 copay. Additional telehealth benefits have a copay between $0 and $25. Opioid treatment program services have a copay of $25. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The BlueJourney Prime (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services include Health Education, Fitness Benefit, Remote Access Technologies, and Kidney Disease Education Services. The plan also covers specific services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay, and a fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $499 and $999, and OTC hearing aids are covered with a $499 copay. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$25, and routine eye exams have no copay. Contact lenses have no copay and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueJourney Prime (PPO) plan covers Medicare dental services with a $25 copay, and other dental services with no copay. Other diagnostic dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueJourney Prime (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, with Durable Medical Equipment (DME) subject to a 20% coinsurance and requiring authorization, and Prosthetics/Medical Supplies subject to a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Outpatient X-ray services have a $20 copay, while diagnostic radiological services have a copay up to $125, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the BlueJourney Prime (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueJourney Prime (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueJourney Prime (PPO), but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $200 per day; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $75 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved