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Blue Cross Medicare Advantage Complete (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Complete (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 Complete (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Complete (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Texas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Blue Cross Medicare Advantage Complete (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 Complete (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 Complete (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 no drug deductible. Your prescription medication coverage will start immediately.
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 Complete (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, 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, while preferred brand drugs have a 31% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services, including emergency and urgent care, have copays. Primary care and preventive services are covered with no copays, and there are also benefits for vision, dental, and hearing services with no or low copays for some services. This plan also covers home health services with no copay, as well as dialysis and home infusion services with coinsurance. Additionally, it provides benefits for medical equipment and diagnostic/radiological services, with copays and coinsurance depending on the specific service. Other benefits include over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Blue Cross Medicare Advantage Complete (PPO) plan. For Inpatient Hospital-Acute, you will pay a $390 copay for days 1-6, and no copay for days 7-90; Additional Days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $270 copay for days 1-6, and no copay for days 7-90; Additional Days are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Outpatient hospital services and observation services have a copay of $395 and $390, respectively, while ambulatory surgical center services have a copay of $300. Individual and group sessions for outpatient substance abuse services have a copay of $75. Outpatient blood services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Complete (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Complete (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $275 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Blue Cross Medicare Advantage Complete (PPO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $50 copay with no coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $22 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions, while physical and speech therapy services have a $40 copay. Additionally, additional telehealth benefits have no copay, and opioid treatment program services have a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, but some services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. There is no copay for eye exams, routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include oral exams with no copay, and dental x-rays and prophylaxis (cleaning) with no copay, but fluoride treatment, implant services, and orthodontics are not covered. Other services such as endodontics, prosthodontics (removable/fixed), maxillofacial prosthetics, and oral and maxillofacial surgery have a 20% coinsurance, while restorative services and adjunctive general services have no coinsurance.
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 with a coinsurance between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Complete (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers medical equipment, including Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies and Diabetic Equipment, both with a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Complete (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 specific services like Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and copays apply; however, the exact copay information is not available in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Blue Cross Medicare Advantage Complete (PPO) plan, but require prior authorization. For days 1-20 and 60-100, there is no copay, but for days 21-59, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for over-the-counter items and meal benefits, with no copay for either. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered by this plan.
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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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