A non-government entity
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 2026, 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 10 County Region. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $163.00. 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 $350.00 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 $7000.00 (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 $7000.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Cross Medicare Advantage Choice (PPO) plan features an annual prescription drug deductible of $350. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a standard pharmacy or preferred mail order service. If you utilize standard mail order for these generic tiers, you will face a $10 copay for a one-month supply and a $20 copay for a two- or three-month supply. Tier 3 preferred brand drugs require a 25% coinsurance and Tier 4 non-preferred drugs require a 50% coinsurance across standard pharmacies, preferred mail order, and standard mail order. For Tier 5 specialty drugs, you will pay a 29% coinsurance for a one-month supply through standard pharmacies and mail order options.
Additional Benefits
The Blue Cross Medicare Advantage Choice (PPO) plan offers affordable coverage with no copays or coinsurance for primary care visits, annual physicals, routine vision exams, and preventive dental care. For specialized medical needs, members pay a predictable $35 copay for specialist visits and a $500 copay per stay for inpatient hospital care. Routine hearing exams are also covered with no copay, though prescription hearing aids require a copay ranging from $599 to $899. Many essential recovery and emergency services are covered with fixed copays and no coinsurance, including a $130 copay for emergency room visits and a $250 copay for ambulance services. Home health services feature no copay, while skilled nursing facility stays have no copay for the first 20 days. Medical equipment and dialysis services require no copays but do carry a 20% to 30% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice (PPO) covers inpatient acute and psychiatric hospital stays with a $500 copay per stay, no coinsurance, and required prior authorization. This benefit is partially covered, as unlimited additional days are included for acute stays, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice (PPO) covers outpatient services with no coinsurance, featuring copays of $10.00 to $350.00 for outpatient hospital services, $350.00 per stay for observation services, and $150.00 for ambulatory surgical center services. Outpatient substance abuse sessions require a $20.00 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Choice (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Choice (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency and urgent care require a $130 copay with no coinsurance, and worldwide emergency transportation has a 20% coinsurance with no copay.
Primary Care See details
Blue Cross Medicare Advantage Choice (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and speech-language pathology require a $35 copay and no coinsurance. Mental health and psychiatric services are covered with a $20 copay and no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Choice (PPO) partially covers preventive services with no copay and no coinsurance for services like annual physical exams, kidney disease education, diabetes self-management, and counseling. However, several additional services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing Services are partially covered by Blue Cross Medicare Advantage Choice (PPO), offering up to two routine hearing exams and unlimited fitting evaluations per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $599.00 to $899.00, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Blue Cross Medicare Advantage Choice (PPO) with no copay, no coinsurance, and no deductible for covered care. This benefit includes up to two routine eye exams per year and a $125 annual maximum for eyewear, while other eye exam services and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice (PPO) offers partially covered dental services up to a $2,000 annual limit, featuring no copay and no coinsurance for preventive care, and a $30 copay with no coinsurance for Medicare-covered dental. Comprehensive dental services carry no copay and 0% to 50% coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance of 0% to 20%, while Part B insulin is covered with a copay of $0 to $35 and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Choice (PPO) with no copays, but requires a 20% to 30% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. While most items are covered with prior authorization required for some, diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice (PPO) diagnostic and radiological services are partially covered and require prior authorization, with diagnostic tests featuring no coinsurance and a $0 to $25 copay, while lab services are not covered. Diagnostic radiological services have no copay and no coinsurance, outpatient X-rays require a $10 copay and coinsurance, and therapeutic radiological services require a minimum 20% coinsurance and a copay.
Home Health Services See details
Blue Cross Medicare Advantage Choice (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Blue Cross Medicare Advantage Choice (PPO) with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Prior authorization is required for covered services, and a copayment applies to additional cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Blue Cross Medicare Advantage Choice (PPO) with no coinsurance, requiring prior authorization. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Blue Cross Medicare Advantage Choice (PPO) plan, which includes acupuncture for a $15.00 copay and no coinsurance (limited to 12 treatments per year) and chronic illness meal benefits with no copay and no coinsurance. Over-the-Counter (OTC) items and other supplemental services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved