A non-government entity
Blue Cross Medicare Advantage Complete (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Complete (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 Complete (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 Cross Medicare Advantage Complete (PPO) is a PPO plan offered by BCBSM, Inc. available for the 2026 plan year to people living in 51 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 Complete (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 Complete (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 Complete (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $197.00. 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 $200.00 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 $3400.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $3400.00 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 $5600.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5600.00 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 Cross Medicare Advantage Complete (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Blue Cross Medicare Advantage Complete (PPO) plan features a $200 drug deductible for prescription coverage. For generic medications, you will pay no copay for Tier 1 preferred generics and Tier 2 generics when using a standard pharmacy or preferred mail order. If you utilize standard mail order for these generic tiers, costs are a $10 copay for a one-month supply and a $20 copay for two- or three-month supplies. Brand-name and specialty drugs are subject to coinsurance under this plan. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 42% coinsurance at standard pharmacies and preferred mail order, increasing to 50% at standard mail order. Specialty Tier 5 drugs are available with a 30% coinsurance for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) plan offers essential medical coverage with no copay and no coinsurance for primary care visits, home health care, and covered preventive services. For hospital needs, members pay a $200 copay per stay for inpatient services and ranging from no copay to a $200 copay for outpatient services. Emergency care is available with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Specialty benefits include routine vision exams and preventive dental care with no copay and no coinsurance, featuring a $315 eyewear allowance and a $2,000 annual dental limit. Routine hearing exams also require no copay, while prescription hearing aids have a copay between $499 and $799. Additionally, durable medical equipment is covered with no copay and a 20% to 25% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Blue Cross Medicare Advantage Complete (PPO) with a $200 copay per stay and no coinsurance for acute and psychiatric stays, although prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Complete (PPO) covers outpatient hospital services with a $0 to $200 copay and observation services with a $200 copay, both with no coinsurance. Ambulatory surgical center services require a $175 copay and no coinsurance, while outpatient substance abuse sessions have a $5 copay with no coinsurance, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Complete (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Complete (PPO) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Cross Medicare Advantage Complete (PPO) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency and urgent care require a $150 copay and no coinsurance, and worldwide emergency transportation is covered with a 20% coinsurance.
Primary Care See details
Blue Cross Medicare Advantage Complete (PPO) features primary care physician services with no copay and no coinsurance, while specialist, physical, and occupational therapy visits have a $25 copay and no coinsurance. Chiropractic benefits are partially covered with a $20 copay and no coinsurance, excluding other chiropractic services, and mental health services require a $5 copay and no coinsurance.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Complete (PPO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and select screenings. This benefit is partially covered, as it excludes in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, and home/bathroom safety modifications.
Hearing Services See details
Hearing services are covered under the Blue Cross Medicare Advantage Complete (PPO) with no copay or coinsurance for fitting evaluations and up to two routine exams per year. Prescription hearing aids are partially covered with no coinsurance and a copay of $499 to $799 for up to two devices annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered by Blue Cross Medicare Advantage Complete (PPO) with no copay, no coinsurance, and no deductible, though the benefit is partially covered because other eye exam services and eyewear upgrades are not covered. Members receive up to two routine eye exams per year and a combined maximum benefit of $315 annually for contacts and eyeglasses.
Dental Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers dental services up to a $2,000 annual limit, offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $20 copay and no coinsurance. Comprehensive services are covered with no copay and 0% to 50% coinsurance, though other diagnostic services, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Complete (PPO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Part B insulin drugs require a $0.00 to $35.00 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Complete (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is partially covered by the Blue Cross Medicare Advantage Complete (PPO), featuring no copays for covered items, though diabetic supplies are not covered. Covered durable medical equipment requires a 20% to 25% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Blue Cross Medicare Advantage Complete (PPO), as lab services are not covered. Covered diagnostic procedures require no coinsurance and a copay of $0 to $10, while radiological services feature no copay for diagnostic imaging, a $5 copay for X-rays, and a 15% coinsurance for therapeutic radiation.
Home Health Services See details
Home health services are covered by the Blue Cross Medicare Advantage Complete (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, other covered additional cardiac rehabilitation services may require a copayment.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Complete (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. Beneficiaries pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers other services, offering acupuncture for a $20 copay and no coinsurance for up to 12 treatments per year with prior authorization, alongside chronic illness meals with no copay or coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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.
SMID: MULTIPLAN_HCIHNMEDADVRX27_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 or 1-800-MEDICARE 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.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
© 2026 Dog Media Solutions LLC. All rights reserved