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Blue Cross Medicare Advantage Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Classic (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Classic (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Classic (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Dallas, Houston, and Austin Markets. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Blue Cross Medicare Advantage 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 Blue Cross Medicare Advantage 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 Blue Cross Medicare Advantage Classic (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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $250.00 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 $11100.00 (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 $11100.00 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 Blue Cross Medicare Advantage Classic (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Classic (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred pharmacies, and preferred brand drugs have 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. This plan may also offer a premium reduction if you qualify for the low-income subsidy.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, with the first six days costing $395 for acute care and $270 for psychiatric care. Outpatient services, including hospital visits, have copays, and ambulance services have copays or coinsurance depending on the type of service. Preventive services, primary care, eye exams, and dental exams have no copays, while specialist visits, chiropractic services, and hearing exams have copays. The plan also includes coverage for hearing aids, vision services, dental services, home infusion, dialysis, medical equipment, diagnostic services, home health, cardiac rehabilitation, and skilled nursing facilities with varying cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Blue Cross Medicare Advantage Classic (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, there is a $270 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, and non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Outpatient Hospital Services and Observation Services have a $375 copay, Ambulatory Surgical Center (ASC) Services have a $295 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $75 copay. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Classic (PPO) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan, but prior authorization is required for all ambulance services. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Coverage, are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage has a $110 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Classic (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $35 copay. Specialist services have a $35 copay. Mental health services and psychiatric services both have a $30 copay for individual or group sessions. Physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits have no copay. Opioid treatment program services have a $35 copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, including fitness benefits and remote access technologies, may have a copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $50 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear includes contact lenses (unlimited), eyeglass lenses (1 pair per year), and eyeglass frames (1 frame per year), all with no copay, with a combined maximum benefit of $125 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $50 copay, as well as oral exams and dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment and orthodontics are not covered, and endodontics, prosthodontics (removable and fixed), and maxillofacial prosthetics are optional supplemental benefits. Restorative Services are covered with no coinsurance, Adjunctive General Services have a 50% coinsurance, Periodontics and Oral and Maxillofacial Surgery have 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Classic (PPO) plan, but require prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment, is covered. DME has a 20% coinsurance with authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance. Diabetic supplies have a 0-20% coinsurance, while 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 a copay ranging from $0 to $100, and lab services with no copay. Radiological services are covered, and there is a copay for diagnostic services up to $325, and 20% coinsurance for therapeutic services. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Classic (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 60-100, but there is a $214 copay for days 21-59. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits. Acupuncture, 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. Over-the-Counter (OTC) Items have no copay, and Meal Benefits also have no copay with a doctor referral.
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