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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 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 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $11300.00 (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 $11300.00 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 Dental Premier (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible is met, you will pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have a $10 copay at preferred pharmacies. You will pay 25% coinsurance for preferred brand and non-preferred drugs.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers a range of benefits with varying costs. This plan includes no copays for many services like primary care, preventive services, routine hearing and vision exams, and many dental services. You'll encounter copays for inpatient and outpatient services, specialist visits, and other services like ambulance, hearing aids, and some therapies. This plan also covers services such as home health, skilled nursing, and diagnostic and radiological services, often with copays or coinsurance. There are additional benefits such as over-the-counter items with no copay, and coverage for prescription hearing aids. However, some services like additional hours of care, certain therapies, and specific types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $385 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you pay a $290 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient Hospital Services have a $395 copay, Observation Services have a $370 copay, and Ambulatory Surgical Center (ASC) Services have a $320 copay. Individual and group sessions for Outpatient Substance Abuse have a copay between $75 and $75. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $250 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, Urgently Needed Services, and Worldwide Emergency Coverage are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $100 copay, and Urgently Needed Services have a $40 copay; all three have no coinsurance. Worldwide Urgent Coverage has a $100 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a $34 copay. Mental Health Specialty Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and other services like Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, all with no copay. 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 exams are covered with a $40 copay, and routine hearing exams have no copay. Fitting/Evaluation for Hearing Aid has no copay. Prescription hearing aids are covered with a copay between $699 and $999, while inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes routine eye exams and eyewear. Routine eye exams and contact lenses have no copay, and eyeglass lenses and frames have no copay. Eyewear has a combined maximum benefit of $100 per year, and eyeglass frames, lenses, and contact lenses are limited to one 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 $35 copay, as well as Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning), each with no copay. Fluoride Treatment, Implant Services, and Orthodontics are not covered. The plan also covers Restorative Services and Adjunctive General Services with no coinsurance, along with Endodontics, Prosthodontics, Maxillofacial Prosthetics, and Prosthodontics, fixed, each with 20% coinsurance, and Periodontics and Oral and Maxillofacial Surgery with 0% - 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan. This plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and 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/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 $60 copay, and Outpatient X-Ray Services with no copay. Prior authorization is required for all services.
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, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Dental Premier (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 are not covered.
Other Services See details
The "Other Services" benefit in the Blue Cross Medicare Advantage Dental Premier (PPO) plan covers over-the-counter items with no copay, and a maximum plan benefit coverage amount of $50.00 every three months. Acupuncture, meal benefits, and several other services are not covered.
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