A non-government entity
Blue Cross Medicare Advantage Protect (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Protect (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 Protect (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Protect (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 Protect (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Cross Medicare Advantage Protect (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 Protect (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $11000.00 (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 $11000.00 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 Protect (PPO)
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Drug Coverage
Prescription drugs are not covered by Blue Cross Medicare Advantage Protect (PPO).
Additional Benefits
The Blue Cross Medicare Advantage Protect (PPO) plan offers comprehensive coverage for various medical services. This includes inpatient hospital stays with a copay that varies by day, as well as outpatient services with copays ranging from $75 to $375. The plan also provides coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay. Additional benefits encompass ambulance services, emergency services, home health, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you pay a $370 copay for days 1-6, and no copay for days 7-90, and additional days are unlimited with no copay; non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $290 copay for days 1-6, and no copay for days 7-90, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered by the Blue Cross Medicare Advantage Protect (PPO) plan, including outpatient hospital services with a $375 copay, observation services with a $370 copay, and ambulatory surgical center services with a $300 copay. Outpatient substance abuse services are covered, with individual and group sessions each having a copay between $75 and $75. Outpatient blood services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Protect (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Protect (PPO) plan. 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, including Worldwide Emergency and Urgent Coverage, are covered under the Blue Cross Medicare Advantage Protect (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Protect (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $55 copay, and mental health specialty services with a $40 copay for individual or group sessions. The 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. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional preventive services, including Fitness Benefit and Remote Access Technologies, are covered with no copay. Other services like Health Education, In-Home Safety Assessment, Personal Emergency Response System, and others are not covered.
Hearing Services See details
Hearing exams have a $40 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 prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear benefits. Eyewear benefits include contact lenses, eyeglass lenses, and eyeglass frames, all with no copay. 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. Other dental services include restorative services with no coinsurance, adjunctive general services with 50% coinsurance, periodontics with 20% coinsurance, and oral and maxillofacial surgery with 20% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered. Endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and orthodontics are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0-20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Protect (PPO) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $100, lab services with no copay, and outpatient X-ray services with no copay. Therapeutic Radiological Services have a coinsurance of at most 20%, and Diagnostic Radiological Services have a copay of at most $300.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Protect (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 specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and the copay information is available below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Blue Cross Medicare Advantage Protect (PPO) plan, but require prior authorization. For days 1-20 and 50-100, there is no copay, and for days 21-49, the copay is $214.
Other Services See details
Other Services are not covered by the Blue Cross Medicare Advantage Protect (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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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.
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