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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 2026, 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 2026 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 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 $375.00 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 $8100.00 (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 $8100.00 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) prescription drug plan has an annual drug deductible of $375. For Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services require copays ranging from $10 to $30 for Tier 1 and $15 to $45 for Tier 2, depending on the supply length. For brand-name and specialty medications, costs are covered through coinsurance at both preferred and standard pharmacies. Tier 3 (Preferred Brand) drugs require a 19% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 40% coinsurance. Tier 5 (Specialty) drugs have a 28% coinsurance and are only available for a one-month supply.
Additional Benefits
The Capital Blue Cross Select (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $200 for days one through five, followed by no copay for days six through 90. Outpatient services feature no coinsurance and copays ranging from no copay up to $450, while emergency room visits require a $115 copay that is waived if admitted. Specialist visits and routine hearing exams require a $25 copay with no coinsurance, and dental benefits cover preventive care with no copay up to a $3,000 annual limit. Vision benefits include eye exams with a copay up to $25 and eyewear coverage up to $175 annually with no copay. Prescription hearing aids are also covered with copays ranging between $499 and $999 and no coinsurance.
Inpatient Hospital See details
Capital Blue Cross Select (PPO) inpatient hospital services are partially covered with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Capital Blue Cross Select (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $450 for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Capital Blue Cross Select (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Capital Blue Cross Select (PPO) covers Medicare-covered ground and air ambulance services with a $360 copay and no coinsurance, though prior authorization is required. While transportation services are technically covered, trips to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Capital Blue Cross Select (PPO) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered up to a $20,000 maximum with similar copays and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are covered by Capital Blue Cross Select (PPO) with no copay and no coinsurance for primary care physician visits and opioid treatment. Most specialist, therapy, and mental health services require a $25 copay and no coinsurance, while chiropractic care is partially covered with routine visits costing a $15 copay and other chiropractic services excluded.
Preventive Services See details
Preventive services are partially covered by Capital Blue Cross Select (PPO) with no copay and no coinsurance for services like annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. While medical nutrition therapy and memory fitness are covered at no cost, other supplemental options such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Capital Blue Cross Select (PPO), as prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. Routine hearing exams require a $25 copay with no coinsurance, while covered prescription hearing aids carry a copay between $499 and $999 with no coinsurance, and OTC hearing aids require a $499 copay with no coinsurance.
Vision Services See details
Vision Services are partially covered by Capital Blue Cross Select (PPO), featuring no coinsurance and a $0 to $25 copay for eye exams, alongside eyewear coverage with no copay or coinsurance up to a $175 annual limit. While routine eye exams and eyeglasses (lenses and frames) are covered, other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Capital Blue Cross Select (PPO) dental services are partially covered up to an annual maximum of $3,000 for both in-network and out-of-network care, featuring a $25 copay and no coinsurance for Medicare-covered dental. Covered preventive services such as oral exams, cleanings, fluoride, and x-rays have no copay and no coinsurance, while covered restorative services and oral surgery require no copay and 50% coinsurance. Other diagnostic and preventive services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Capital Blue Cross Select (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Capital Blue Cross Select (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Capital Blue Cross Select (PPO) covers medical equipment, prosthetics, and diabetic supplies with no copay, though prior authorization is required. Covered items generally require a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance and may be limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Capital Blue Cross Select (PPO) with no copay and no coinsurance for diagnostic tests, procedures, lab services, and diagnostic radiological services. Outpatient X-rays require a $25 copay and therapeutic radiological services require a 20% coinsurance, with prior authorization required for these covered services.
Home Health Services See details
Home Health Services are covered by Capital Blue Cross Select (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Capital Blue Cross Select (PPO) covers some cardiac rehabilitation services with no copay and no coinsurance. However, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Capital Blue Cross Select (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $210 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Capital Blue Cross Select (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $35 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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