A non-government entity
Blue Cross Medicare Advantage Dental Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (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 Dental Premier (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 Dental Premier (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 $590.00 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:
Sign up for Blue Cross Medicare Advantage Dental Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Cross Medicare Advantage Dental Premier (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $10 copay at preferred pharmacies and a $20 copay at standard pharmacies. For preferred brand drugs, you'll pay 30% coinsurance at preferred pharmacies and 35% coinsurance at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your drugs.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services with varying copays, as well as coverage for emergency services, primary care, and preventive services with no copays for many services. The plan also includes coverage for hearing and vision services, with copays for hearing exams and prescription hearing aids, and no copay for eye exams and eyewear. Dental services are covered, including oral exams and dental x-rays with no copay. Additional benefits include ambulance services with copays or coinsurance, home health services, and skilled nursing facility stays with no copay for the first 20 days. The plan also covers home infusion bundled services, dialysis services, medical equipment, and diagnostic services. The plan does not cover some services, such as certain cardiac rehabilitation services, and has an OTC benefit of $35.00 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $380 copay for days 1-6, and no copay for days 7-90, while Additional Days have no copay. For Inpatient Hospital Psychiatric, you will pay a $290 copay for days 1-6, and no copay for days 7-90, while Additional Days are not covered. Non-Medicare-covered stays and Upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $395 copay, Observation Services with a $380 copay, Ambulatory Surgical Center (ASC) Services with a $350 copay, and Outpatient Substance Abuse Services with a $75 copay for both individual and group sessions. Outpatient Blood Services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $275 copay, while air ambulance services have 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 under the Blue Cross Medicare Advantage Dental Premier (PPO) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $100 copay; all have no coinsurance.
Primary Care See details
The Blue Cross Medicare Advantage Dental Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay (routine care not covered), occupational therapy services with a $40 copay, physician specialist services with a $42 copay, and mental health specialty services with a $40 copay for individual and group sessions. This plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $50 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, including fitness benefits, with no copay. Also included are kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, with a $40 copay, and routine hearing exams with no copay. Fitting/Evaluation for Hearing Aid benefits are covered with no copay, and prescription hearing aids have a copay between $699 and $999 depending on the type of hearing aid. 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. Eye exams have no copay, while eyewear has a $100 combined maximum benefit per year, with no copay. Contact lenses, eyeglass lenses, and eyeglass frames are covered; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, Oral Exams with no copay, Dental X-Rays with no copay, and Prophylaxis (Cleaning) with no copay, but Fluoride Treatment, Implant Services, and Orthodontics are not covered. Restorative Services and Adjunctive General Services have no coinsurance, Endodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Prosthodontics (fixed) have 20% coinsurance, and Periodontics, and Oral and Maxillofacial Surgery have between 0% and 20% coinsurance. Orthodontic Services have a maximum plan benefit of $5,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, but require prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, including durable medical equipment (DME), prosthetic devices, medical supplies, and diabetic equipment. DME has a 20% coinsurance and requires prior authorization, while diabetic supplies have a coinsurance between 0% and 20% and diabetic therapeutic shoes/inserts have a 20% coinsurance; both require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a minimum copay of $0 and a maximum copay of $100 for Diagnostic Procedures/Tests, and no copay for Lab Services. Diagnostic Radiological Services have a maximum copay of $300, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) plan. While the plan covers some Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, with a $0 copay for days 1-20, a $214 copay for days 21-59, and a $0 copay for days 60-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the Blue Cross Medicare Advantage Dental Premier (PPO) plan include Over-the-Counter (OTC) Items with no copay, but acupuncture, meal benefits, 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. The OTC benefit has a maximum coverage amount of $35.00 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved