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Blue Medicare Advantage PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Advantage PPO (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Blue Medicare Advantage PPO (PPO) is a PPO plan offered by Wellmark Advantage Health Plan, Inc. available for the 2026 plan year to people living in Iowa. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Blue Medicare Advantage PPO (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 Medicare Advantage PPO (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 Medicare Advantage PPO (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 $300.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4150.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4150.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $5500.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Medicare Advantage PPO (PPO)
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Drug Coverage
The Blue Medicare Advantage PPO (PPO) plan features a $300 annual drug deductible before coverage begins. For Tier 1 preferred generic drugs, there is no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are highly affordable, with copays starting at $5 for a one-month supply and reaching up to $15 at standard pharmacies or $12.50 through mail order for a three-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for all supply lengths. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply through standard pharmacies or mail order.
Additional Benefits
The Blue Medicare Advantage PPO (PPO) plan offers comprehensive medical coverage with predictable costs, including no copay for primary care visits and no coinsurance for inpatient hospital stays. For hospitalizations, you will pay a $380 daily copay for the first six days, while emergency room visits require a $125 copay that is waived if you are admitted. Outpatient services, diagnostic testing, and medical equipment are also covered, though these services typically require prior authorization and may involve copays or coinsurance. Routine wellness benefits include no copay for preventive care, annual physicals, routine hearing exams, and preventive dental services. Vision care is covered with a routine eye exam and up to $50 annually for eyewear, while comprehensive dental services are available with up to a 25% coinsurance and a $1,000 yearly limit. Note that this plan does not cover hearing aids, fitness programs, over-the-counter items, or meal benefits.
Inpatient Hospital See details
Blue Medicare Advantage PPO (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $380 daily copay for days 1 through 6 and no copay for days 7 and beyond. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Blue Medicare Advantage PPO (PPO) covers outpatient services with no coinsurance, featuring copays of $45 to $500 for outpatient hospital services, $375 per stay for observation services, and $300 for ambulatory surgical center services, with prior authorization required. Outpatient substance abuse services require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Blue Medicare Advantage PPO (PPO) with a $105.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Blue Medicare Advantage PPO (PPO) covers ground and air ambulance services with a $440 copay and no coinsurance, both of which require prior authorization. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under the Blue Medicare Advantage PPO (PPO) are covered with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $55 copay with no coinsurance, and worldwide emergency benefits are covered up to $50,000 with no coinsurance and copays of $125 for emergency or urgent care and $440 for emergency transportation.
Primary Care See details
Blue Medicare Advantage PPO (PPO) provides partially covered primary care and specialist benefits with no coinsurance, though podiatry services are not covered. Under this plan, primary care visits and opioid treatment have no copay, while other services like specialist visits, chiropractic care, therapies, and mental health sessions have copays ranging from $20 to $45.
Preventive Services See details
Blue Medicare Advantage PPO (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. While remote access technologies are included, additional preventive services are only partially covered, with sub-services such as fitness benefits, health education, weight management, and nutritional therapy not covered by the plan.
Hearing Services See details
Hearing services are partially covered by the Blue Medicare Advantage PPO (PPO), which offers one routine hearing exam every year with no copay and no coinsurance. Fitting and evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered under this plan.
Vision Services See details
Blue Medicare Advantage PPO (PPO) offers partially covered vision services, including one routine eye exam per year with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance, offering up to a $50 annual maximum benefit for contact lenses and eyeglass frames.
Dental Services See details
Dental services are partially covered by the Blue Medicare Advantage PPO (PPO), offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $45 copay and no coinsurance. Comprehensive dental services, including restorative care, endodontics, periodontics, prosthodontics, and oral surgery, have no copay and 0% to 25% coinsurance up to a $1,000 annual limit; however, other diagnostic and preventive services, adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Medicare Advantage PPO (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Medicare Advantage PPO (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Blue Medicare Advantage PPO (PPO) with no copays, though prior authorization and coinsurance may apply. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is partially covered with no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Medicare Advantage PPO (PPO), requiring prior authorization for all services. Diagnostic tests and lab services feature no coinsurance with copays of $40 and $10 respectively, while radiological services require a $20 copay and coinsurance for X-rays, a minimum $210 copay for diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology.
Home Health Services See details
Blue Medicare Advantage PPO (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Blue Medicare Advantage PPO (PPO) provides Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Medicare Advantage PPO (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Medicare Advantage PPO (PPO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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