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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.
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 15 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 $248.00. 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 $250.00 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 $3500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $3500.00 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 $5700.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5700.00 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)
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Drug Coverage
The Blue Cross Medicare Advantage Complete (PPO) plan features an annual drug deductible of $250. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard pharmacies or preferred mail order services for any supply length up to three months. Standard mail order for these generic tiers requires a $10 copay for a one-month supply and a $20 copay for a two- or three-month supply. Brand name and specialty medications under this plan are subject to coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 45% to 50% coinsurance depending on your pharmacy choice. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply across standard pharmacies and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits and routine preventive services. Specialist visits, physical therapy, and occupational therapy require a $20 copay with no coinsurance, while inpatient hospital stays carry a $250 copay per admission. Emergency care is available with a $150 copay, which is waived upon admission, and urgent care visits require a $30 copay. For ancillary care, routine dental, vision, and hearing exams are covered with no copay and no coinsurance, featuring a $200 annual eyewear allowance and up to $2,000 in dental benefits. Home health services also feature no copay and no coinsurance, while skilled nursing facility stays have no copay for the first 20 days before transitioning to a daily copay. Durable medical equipment and dialysis services require no copays, instead carrying 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 and no coinsurance, though prior authorization is required. This benefit is partially covered, as 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, and ambulatory surgical center services with a $100 copay and no coinsurance. Outpatient substance abuse services require a $5 copay with no coinsurance, while outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
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, with prior authorization required. While transportation services are listed as covered, some services are covered but transportation to plan-approved health-related locations or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered under the Blue Cross Medicare Advantage Complete (PPO) plan with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $30 copay and no coinsurance, while worldwide emergency and urgent care carry a $150 copay, and worldwide emergency transportation requires 20% coinsurance.
Primary Care See details
Blue Cross Medicare Advantage Complete (PPO) provides primary care physician visits with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy services require a $20 copay and no coinsurance. Mental health and psychiatric sessions have a $5 copay and no coinsurance, some chiropractic services are covered with a $20 copay and no coinsurance (though routine and other chiropractic services are not covered), and podiatry is not covered.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Complete (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. Additional preventive benefits are partially covered with no copay and no coinsurance for health education, counseling, and memory fitness, but do not cover services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers hearing services, offering routine hearing exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $499 to $799, but over-the-counter hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Complete (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for routine eye exams and eyewear. This benefit includes up to two routine eye exams per year and a $200 annual allowance for contacts or eyeglasses, though other eye exam services and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers dental services up to a $2,000 annual maximum, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 0% to 50% coinsurance. Medicare-covered dental services require a $20 copay and no coinsurance, while other diagnostic, other preventive, 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, subject to prior authorization and step therapy requirements. Under this benefit, Medicare Part B insulin drugs have a copay ranging from $0 to $35 and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Blue Cross Medicare Advantage Complete (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Complete (PPO) with no copays, featuring a 20% to 25% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered, offering diabetic therapeutic shoes and inserts with no copay and 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers diagnostic and radiological services with prior authorization, though lab services are not covered. Covered diagnostic procedures carry no coinsurance and a $0 to $10 copay, while radiological services range from no copay and no coinsurance for diagnostic radiology to a $5 copay plus coinsurance for X-rays, and a copay with a minimum 15% coinsurance for therapeutic radiology.
Home Health Services See details
Blue Cross Medicare Advantage Complete (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Complete (PPO) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Covered services require prior authorization and a copayment.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Complete (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Blue Cross Medicare Advantage Complete (PPO) partially covers other services, including acupuncture for a $20 copay and no coinsurance for up to 12 treatments yearly, and chronic illness meals with no copay and no coinsurance. Over-the-counter (OTC) items are not covered.
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.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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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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