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Blue Shield Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Shield Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Shield Select (PPO) in 2025, please refer to our full plan details page.
Blue Shield Select (PPO) is a PPO plan offered by California Physicians' Service available for enrollment in 2025 to people living in Orange and San Diego Counties. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Blue Shield Select (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 Shield Select (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 Shield Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.00. 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 $8950.00 (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 $8950.00 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 Shield Select (PPO)
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Drug Coverage
The Blue Shield Select (PPO) plan has an enhanced alternative drug benefit with no deductible. In the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you'll pay $19.00.
Additional Benefits
The Blue Shield Select (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays for each. Emergency, primary care, and preventive services are also covered, with copays ranging from $5 to $125. The plan also includes coverage for hearing, vision, and dental services, offering benefits like routine eye exams, hearing exams, and dental cleanings, but some services like orthodontics and specific hearing aid types are not covered. Additional benefits of the Blue Shield Select (PPO) plan include ambulance, partial hospitalization, and home health services. The plan also covers medical equipment, diagnostic and radiological services, and home infusion services, with different cost-sharing structures like copays and coinsurance. The plan also offers coverage for skilled nursing facilities, cardiac rehabilitation services, and other services like over-the-counter items and nicotine replacement therapy.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute services, with a $200 copay for days 1-7 and no copay for days 8-90, and Inpatient Hospital Psychiatric services, with a $1660 copay per admission or stay. Additional days for Inpatient Hospital-Acute are also covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Blue Shield Select (PPO) plan, including outpatient hospital services with a $250 copay, observation services with a $10 copay, ambulatory surgical center services with a $100 copay, and outpatient substance abuse services with a $35 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Shield Select (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 under the Blue Shield Select (PPO) plan. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Shield Select (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $10 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Shield Select (PPO) plan covers primary care physician services with a $5 copay, and chiropractic services with a $20 copay. Occupational therapy services have a $25 copay, while physical therapy and speech-language pathology services have a $25 copay. Physician specialist services have a copay between $0 and $25. Mental health and psychiatric services, including individual and group sessions, have a $35 copay. Other health care professional services have a copay between $5 and $25. Podiatry services are not covered.
Preventive Services See details
The Blue Shield Select (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional services, with services like Health Education, In-Home Safety Assessment, and others not covered. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing Services are covered by the Blue Shield Select (PPO) plan. Routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered for two visits every two years. Prescription hearing aids have a maximum plan benefit of $1000 every two years, and prescription hearing aids (all types) are covered for two visits every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a $25 copay for routine eye exams. Contact lenses are covered with a maximum plan benefit coverage amount of $220, while eyeglass lenses and frames are also covered, with a limit of one pair of lenses per year, and one frame every two years with a maximum plan benefit coverage amount of $220.
Dental Services See details
The Blue Shield Select (PPO) plan covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatments, and other preventive dental services with a copay between $5 and $25. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and no copay, and Prosthetic Devices with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Blue Shield Select (PPO) plan. Diagnostic Procedures/Tests and Lab Services are not covered, while Diagnostic Radiological Services have a copay of at most $35.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Blue Shield Select (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Blue Shield Select (PPO) plan, but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Shield Select (PPO) plan, with a $0 copay for days 1-20, and a $180 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services with Blue Shield Select (PPO) covers over-the-counter items with a maximum benefit coverage amount of $40 every three months, and nicotine replacement therapy, 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.
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