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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 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Complete (PPO) is a PPO plan offered by Aware Integrated, Inc. available for enrollment in 2025 to people living in 51 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 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 $228.00. 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 $5100.00 (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 $5100.00 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 Complete (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Complete (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, or a $5 copay at a standard mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) plan offers coverage for a wide range of services with varying cost-sharing. Inpatient hospital stays have no copay for the first 60 days, with a $150 copay thereafter. Outpatient services have copays between $0 and $150, and emergency services range from $30 to $140. This plan also includes coverage for primary care, preventive, hearing, vision, and dental services, with specific copays and annual maximums for some benefits. Additional benefits include home health services with no copay, and coverage for medical equipment, home infusion, and dialysis services with varying coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, there is no copay for days 1-60, and for Medicare-covered stays, there is a $150 copay, and for Inpatient Hospital Psychiatric, there is a $150 copay for Medicare-covered stays.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $150, and observation services with a $150 copay. Ambulatory Surgical Center (ASC) Services have a $125 copay, and Outpatient Substance Abuse Services have a $10 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 Complete (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 by the Blue Cross Medicare Advantage Complete (PPO) plan. Ground and Air Ambulance Services have a $200 copay, and there is no coinsurance. 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 by the Blue Cross Medicare Advantage Complete (PPO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Services have a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, while Worldwide Emergency Transportation has a 20% coinsurance.
Primary Care See details
Primary Care benefits include coverage for primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services are covered with a $20 copay, but routine care is not covered. Individual and group sessions for mental health and psychiatric services have a $10 copay, while physical therapy and speech-language pathology services, and physician specialist services have a $20 copay. Other health care professional services have a copay that ranges from $10-$20, and opioid treatment program services have a copay that ranges from $20-$20.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, health education, fitness benefits, remote access technologies, counseling services, kidney disease education services, and other preventive services like glaucoma screenings, are covered. Some preventive services, such as in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams (2 visits per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $499 and $799, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Routine eye exams are covered for two visits per year, and eyewear has a combined maximum benefit of $200 per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $20 copay for Medicare Dental Services. Other dental services are covered, with a maximum plan benefit of $2,000 per year. Oral Exams are covered up to 5 visits, Dental X-Rays are covered up to 10, Prophylaxis (Cleaning) is covered up to 2 visits, and Fluoride Treatment is covered up to 2 visits. Restorative Services have a coinsurance between 30% and 50%, Adjunctive General Services have a coinsurance between 0% and 50%, Endodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery have a 50% coinsurance. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a copay between $0 and $35. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Complete (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), is covered by the Blue Cross Medicare Advantage Complete (PPO) plan. DME has a coinsurance between 20% and 25%, and Prosthetic Devices have a 25% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 15% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for diagnostic procedures and tests with a copay between $0 and $10, and diagnostic radiological services with a copay up to $50.00. Therapeutic radiological services have a 10% coinsurance, and outpatient X-ray services have a $5 copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Complete (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 not covered by the Blue Cross Medicare Advantage Complete (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Complete (PPO) plan, with a prior authorization requirement. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers acupuncture with a $20 copay and over-the-counter (OTC) items with a maximum benefit coverage amount of $50 every three months. The plan also provides a meal benefit for chronic illnesses and covers some additional services, while others such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Private Duty Nursing Services are not covered.
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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.
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