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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 Oklahoma. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $10100.00 (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 $10100.00 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:
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Drug Coverage
The Blue Cross Medicare Advantage Classic (PPO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for preferred generic drugs, you will pay a $10 copay at a preferred pharmacy and $20 at a standard pharmacy. For preferred brand drugs, you will pay 50% coinsurance, regardless of the pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers comprehensive coverage, including inpatient and outpatient services, with varying copays. You'll find no copay for many services like primary care, preventive services, and home health, while others have set copays, such as $375 for outpatient services and $120 for emergency services. The plan also includes benefits for hearing, vision, and dental, with specific copays and coverage limits for each. Additional benefits include coverage for ambulance services, with a $250 copay for ground transport and 20% coinsurance for air ambulance. You'll also have access to medical equipment, diagnostic services, and other services like OTC items with a quarterly allowance. However, some services like cardiac rehabilitation and certain dental and vision procedures may not be covered, so reviewing the specifics of each benefit is essential.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric services have a $225 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a $375 copay, while Ambulatory Surgical Center (ASC) Services have a $250 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $75 and $75, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Classic (PPO) plan, but requires prior authorization. You will have a $55 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. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. 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 Blue Cross Medicare Advantage Classic (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $40 copay; all three have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Classic (PPO) plan offers primary care services with no copay, chiropractic services with a $20 copay, occupational therapy with a $40 copay, and physician specialist services with a $40 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, physical therapy and speech-language pathology services have a $40 copay, and telehealth services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Classic (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, like fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay. However, health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types of prescription hearing aids, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with no copay and eyewear with a $35 copay. Eyewear has a combined maximum benefit of $100 per year. Contact lenses and eyeglass lenses have no copay, and eyeglass frames have no copay for one pair per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay, but fluoride treatment is not covered. Orthodontic services are covered with a maximum plan benefit of $1,000 per year, restorative services have no coinsurance, adjunctive general services have a 50% coinsurance, periodontics have a 20% coinsurance, and oral and maxillofacial surgery has a 20% coinsurance. Endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and implant services are not covered, and orthodontics is also not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Durable medical equipment has a 20% coinsurance, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have a 0-20% coinsurance, with diabetic therapeutic shoes/inserts having a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $100, lab services with a $5 copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with a $45 copay, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
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 not covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Prior authorization is required for these services.
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 50-100, but there is a $214 copay for days 21-49. Additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $70 every three months, and the plan offers nicotine replacement therapy as an OTC benefit, but acupuncture, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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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.
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