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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 2026, 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 4.5 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 $243.00. 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. 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 $5600.00 (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 $5600.00 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:
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Drug Coverage
The Blue Cross Medicare Advantage Complete (PPO) plan features a $200 annual drug deductible. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using a standard retail pharmacy or preferred mail order service. If you use standard mail order for these generic tiers, the cost is a $10 copay for a one-month supply or a $20 copay for a two- to three-month supply. For brand-name and specialty drugs, your costs are determined by coinsurance. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs require a 42% coinsurance, which increases to 50% if filled through standard mail order. Tier 5 specialty drugs carry a 30% coinsurance for a one-month supply across all standard pharmacy and mail order options.
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) plan offers comprehensive coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits and preventive care. Specialist visits, physical therapy, and occupational therapy require a $30 copay, while inpatient hospital stays carry a $250 copay per admission with no copay for the first 60 days. Emergency services are covered with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. For supplemental wellness, members benefit from no copay on routine eye and hearing exams, alongside a $280 annual eyewear allowance and up to a $2,000 annual maximum for dental care. Prescription hearing aids are covered with copays ranging from $499.00 to $799.00, and home health services are available with no copay. Additionally, durable medical equipment is covered with a 20% to 25% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Complete (PPO) covers inpatient acute and psychiatric hospital stays with a $250 copay per admission, no coinsurance, and no copay for days 1 to 60, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Complete (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $250, observation services for a $250 copay per stay, and ambulatory surgical center services for a $225 copay. Outpatient substance abuse sessions have a $5 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Complete (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
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, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Complete (PPO) covers emergency services with a $150 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $30 copay, both featuring no coinsurance. Worldwide emergency and urgent services are also covered with a $150 copay and no coinsurance, while worldwide emergency transportation is covered with a 20% coinsurance.
Primary Care See details
Blue Cross Medicare Advantage Complete (PPO) covers primary care physician services with no copay and no coinsurance, while specialists, physical therapy, occupational therapy, and opioid treatment require a $30 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance for up to 12 routine visits per year, but other chiropractic services are not covered. Additional services like mental health, podiatry, and telehealth are covered with no coinsurance and copays ranging from $0 to $30.
Preventive Services See details
Preventive Services are partially covered under the Blue Cross Medicare Advantage Complete (PPO) plan with no copay and no coinsurance for covered care like annual physicals and counseling. However, sub-services such as weight management programs, personal emergency response systems, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Hearing Services are partially covered under the Blue Cross Medicare Advantage Complete (PPO) plan, which offers routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Covered prescription hearing aids require no coinsurance and a copay ranging from $499.00 to $799.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Complete (PPO) provides partially covered vision services with no copay, no coinsurance, and no deductible. Eligible members receive up to two routine eye exams per year and a $280 annual allowance for contacts and eyeglasses, though upgrades and other eye exam services are not covered.
Dental Services See details
Blue Cross Medicare Advantage Complete (PPO) offers partially covered dental services with a $2,000 annual maximum, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for comprehensive treatments. Preventive care like cleanings and exams has no copay and no coinsurance, but other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Complete (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a copay of $0 to $35 and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Complete (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Complete (PPO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered durable medical equipment (DME) carries a 20% to 25% coinsurance, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers diagnostic and radiological services, with lab services being excluded from coverage. Covered diagnostic procedures and tests carry no coinsurance and a copay ranging from no copay to $10, while radiological services require prior authorization and range from no copay for diagnostic radiology to a $5 copay for X-rays and a minimum 15% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Blue Cross Medicare Advantage Complete (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Complete (PPO) indicates that some Cardiac Rehabilitation Services are covered, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Covered services require prior authorization and carry no coinsurance, with copayments ranging from $30 to $35.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Complete (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the 100 Medicare-covered days are not covered.
Other Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers other services, offering acupuncture with a $20 copay and no coinsurance, and a meal benefit for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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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.
* 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.
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