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Capital Blue Cross Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Capital Blue Cross Select (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 Select (PPO) in 2025, please refer to our full plan details page.
Capital Blue Cross Select (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 Capital Blue Cross Select (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 Select (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 Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $200.00 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 $7000.00 (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 $7000.00 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 Select (PPO)
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Drug Coverage
The Capital Blue Cross Select (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at a preferred pharmacy. For standard generic drugs, you pay 20% coinsurance, and for preferred brand drugs, you pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Capital Blue Cross Select (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $150 copay for the first four days, with no copay thereafter. Outpatient services have copays ranging from $0 to $375. This plan includes coverage for primary care with no copay for primary care physician services. Preventive services, such as annual physical exams, are also covered with no copay. The plan also covers hearing, vision, and dental services, with copays and coinsurance varying by service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $150 copay for days 1-4 and no copay for days 5-90, while for Inpatient Hospital Psychiatric, you also pay a $150 copay for days 1-4 and no copay for days 5-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered with a copay ranging from $0 to $375 for outpatient hospital services and a $325 copay for observation services. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Capital Blue Cross Select (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Capital Blue Cross Select (PPO) plan. Ground and Air Ambulance Services have a $325 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Capital Blue Cross Select (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services, a $25 copay for Occupational Therapy Services, a $30 copay for Physician Specialist Services, and a $25 copay for Physical Therapy and Speech-Language Pathology Services. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a copay of $30. Additional Telehealth Benefits have a copay between $0 and $30.
Preventive Services See details
Preventive Services includes coverage for Annual Physical Exams with no copay. Other preventive services such as Health Education, Kidney Disease Education Services, and Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams are covered once per year. Prescription hearing aids are partially covered, with a copay between $499 and $999 for all types of hearing aids, and OTC hearing aids are covered with a $499 copay for up to two hearing aids per year. Fitting/Evaluation for Hearing Aid is covered.
Vision Services See details
Vision Services include eye exams and eyewear. Routine eye exams have no copay, while other eye exams may have a copay between $0 and $30. Contact lenses, eyeglasses (lenses and frames) are covered, with a combined maximum of $150 per year.
Dental Services See details
The Capital Blue Cross Select (PPO) plan covers Medicare Dental Services with a $30 copay, and Other Dental Services with no copay. Other covered services include oral exams, dental x-rays, other diagnostic dental services with a 50% coinsurance, prophylaxis (cleaning), fluoride treatment, restorative services with a 50% coinsurance, adjunctive general services with a 50% coinsurance, endodontics with a 50% coinsurance, periodontics with a 50% coinsurance, prosthodontics (removable) with a 50% coinsurance, prosthodontics (fixed) with a 50% coinsurance, and oral and maxillofacial surgery with a 50% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Capital Blue Cross Select (PPO) plan, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Capital Blue Cross Select (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
The Capital Blue Cross Select (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires prior authorization, but does not cover DME for use outside the home. Prosthetics, medical supplies, and diabetic equipment are covered with 20% coinsurance, and diabetic supplies have no copay, while diabetic therapeutic shoes/inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $200, while Therapeutic Radiological Services have a maximum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Capital Blue Cross Select (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 under the Capital Blue Cross Select (PPO) plan. The plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Capital Blue Cross Select (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services in the Capital Blue Cross Select (PPO) plan cover over-the-counter items with a maximum benefit of $75 every three months, but acupuncture, meal benefits, and other listed services are not covered.
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