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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) plan features an annual drug deductible of $375. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for one, two, or three-month supplies when using preferred pharmacies or preferred mail-order services. If using standard pharmacies or standard mail order, Tier 1 drugs require a copay starting at $10, while Tier 2 drugs start at a $15 copay for a one-month supply. For higher-tier medications, costs transition to coinsurance percentages across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs have a 40% coinsurance for all supply durations. Tier 5 specialty drugs are covered with a 28% coinsurance for a one-month supply.
Additional Benefits
Capital Blue Cross Select (PPO) offers robust coverage for essential medical services with no coinsurance for inpatient stays, doctor visits, and emergency care. Members pay no copay for primary care and preventive services, while specialist visits require a $25 copay and inpatient hospital stays require a $200 daily copay for the first five days. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours. Supplemental benefits include dental coverage with a $3,000 annual limit and vision benefits with no copay for eyewear up to a $175 limit. Routine hearing exams have a $25 copay, and the plan provides a $35 quarterly allowance for over-the-counter items with no copay. Home health services are fully covered with no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance.
Inpatient Hospital See details
Capital Blue Cross Select (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. Unlimited additional days are covered for acute stays, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Capital Blue Cross Select (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $450, observation services require a $325 copay per stay, and outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Capital Blue Cross Select (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Capital Blue Cross Select (PPO) covers ground and air ambulance services with a $365.00 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Capital Blue Cross Select (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $20,000 maximum with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Capital Blue Cross Select (PPO) covers primary care physician and opioid treatment services with no copay and no coinsurance, while specialists, mental health, and therapy services require a $25 copay and no coinsurance. Chiropractic care is partially covered with no coinsurance and a $15 copay for routine visits, but other chiropractic services are not covered.
Preventive Services See details
Capital Blue Cross Select (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance, excluding health education, weight management programs, and in-home safety assessments.
Hearing Services See details
Capital Blue Cross Select (PPO) covers hearing services, including routine hearing exams for a $25 copay and no coinsurance, and up to two OTC hearing aids per year for a $499 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $499 to $999 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Capital Blue Cross Select (PPO) with no deductible, no coinsurance, and copays ranging from $0 to $25 for eye exams and no copay for eyewear. While routine eye exams and contact lenses or eyeglasses are covered up to a $175 annual limit, other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Capital Blue Cross Select (PPO) partially covers dental services up to a $3,000 annual limit, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for other covered services like cleanings, exams, fillings, and simple extractions. Sub-services not covered under this plan include other diagnostic, other preventive, adjunctive general, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Capital Blue Cross Select (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Capital Blue Cross Select (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment benefits under Capital Blue Cross Select (PPO) are covered with no copays, though coinsurance is required for most items. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Capital Blue Cross Select (PPO) covers diagnostic services with no copay and no coinsurance, and diagnostic radiological services with no copay, though prior authorization is required. Outpatient X-rays require a $25 copay plus coinsurance, while therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Capital Blue Cross Select (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Capital Blue Cross Select (PPO) covers Cardiac Rehabilitation Services with no coinsurance, and while some services are covered, specific programs like cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Capital Blue Cross Select (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $215 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services for Capital Blue Cross Select (PPO) are partially covered, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a $35 allowance every three months. Acupuncture and meal benefits are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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