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Blue Cross Medicare Advantage Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice (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 Choice (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice (PPO) is a PPO plan offered by Aware Integrated, Inc. available for enrollment in 2025 to people living in 15 County Region. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Blue Cross Medicare Advantage Choice (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 Choice (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 Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $144.00. 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 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 $5150.00 (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 $5150.00 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 Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Choice (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs depending on the drug tier and the pharmacy you use. For example, you will have no copay for preferred generic drugs at a preferred pharmacy or through mail order, while standard generic drugs have a 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Cross Medicare Advantage Choice (PPO) plan offers comprehensive coverage, including inpatient hospital stays with no copay for the first 60 days, and outpatient services with varying copays. You'll find coverage for primary care, preventive services, hearing, vision, and dental, with specific copays and coinsurance amounts depending on the service. The plan also includes benefits like ambulance services, emergency care, and home health services, along with other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Blue Cross Medicare Advantage Choice (PPO) plan. For Inpatient Hospital-Acute, there is no copay for days 1-60, but a $250 copayment for a Medicare-covered stay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $250 copayment for a Medicare-covered stay. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under this plan, including outpatient hospital services with a $10-$250 copay, observation services with a $250 copay, ambulatory surgical center services with a $225 copay, and outpatient substance abuse services with a $15 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Blue Cross Medicare Advantage Choice (PPO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Blue Cross Medicare Advantage Choice (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $40 copay. Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $140 copay, and Worldwide Emergency Transportation has 20% coinsurance.
Primary Care See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy services (with a $35 copay), physician specialist services (with a $35 copay), mental health specialty services (with a $15 copay for individual and group sessions), other health care professional services (with a $20 copay), psychiatric services (with a $15 copay for individual and group sessions), physical therapy and speech-language pathology services (with a $35 copay), additional telehealth benefits, and opioid treatment program services (with a $35 copay). Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, fitness benefits (Memory Fitness), Remote Access Technologies, Counseling Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System, 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, and Home and Bathroom Safety Devices and Modifications are not covered.
Hearing Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, and covers routine hearing exams up to 2 times per year. Prescription hearing aids (all types) are covered with a copay between $599 and $899 per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams with 2 visits every year, and eyewear with a combined maximum of $125 per year for both in-network and out-of-network services; contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. Upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers dental services, including oral exams with a $30 copay, dental x-rays, prophylaxis (cleaning), and fluoride treatments. This plan also covers restorative services with 30%-50% coinsurance, and endodontics, prosthodontics (removable, fixed), implant services, oral and maxillofacial surgery, with 50% coinsurance. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan, including Medicare Part B Insulin Drugs with a copay of $0-$35. 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 under the Blue Cross Medicare Advantage Choice (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 20% and 30%, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items, and Diabetic Therapeutic Shoes/Inserts with a 15% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered lab services, and a copay between $0 and $25 for diagnostic procedures/tests. Radiological Services include coverage for diagnostic radiological services with a copay up to $100, therapeutic radiological services with 15% coinsurance, and outpatient X-ray services with a $10 copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan with no copay and no coinsurance, although authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but there is no information about the cost. 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 Choice (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture with a $20 copay and a limit of 12 treatments per year, over-the-counter items up to $50 every three months, and a meal benefit for chronic illness. This plan does not cover 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.
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