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 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 15 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)
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 Complete (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and pharmacy. For example, you pay no copay for preferred generic drugs at a standard pharmacy, while you pay a $5 copay for a 90-day supply of the same drug through standard mail. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium for the plan is reduced.
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) plan offers a range of benefits with varying costs. Hospital stays have no copay for the first 60 days, with outpatient services and primary care visits generally costing a $20 copay. Emergency services have a $140 copay, and ambulance services have a $200 copay. This plan includes coverage for preventive services, hearing, vision, and dental services. Vision and preventive services have no copay, while hearing services and dental services have a copay. Other covered services include home health with no copay, and skilled nursing with a copay after 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization required. For Inpatient Hospital-Acute, there is no copay for days 1-60, and for Inpatient Hospital Psychiatric, the copay is $150 per admission or stay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $150, observation services have a $150 copay, ambulatory surgical center services have a $125 copay, and individual and group sessions for outpatient substance abuse have a copay between $10 and $10.
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.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Complete (PPO) plan. Both ground and air ambulance services have a $200 copay, with no coinsurance, but 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, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a 20% coinsurance.
Primary Care See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers primary care physician services, occupational therapy, physician specialist services, mental health specialty services, other healthcare professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services are covered with a $20 copay, and routine chiropractic care is not covered. Individual and group mental health and psychiatric sessions have a minimum copay of $10 and a maximum copay of $10. Other covered services have a $20 copay. Physical therapy and speech-language pathology services require a $20 copay.
Preventive Services See details
Preventive services, including health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered. In-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams (up to 2 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $499 and $799 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with 2 visits per year, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $200 per year for all eyewear; upgrades are not covered. There is no copay or coinsurance for any of the covered services.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $20 copay, and other dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, but have limits on the number of visits. Restorative services, endodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with 30%-50% coinsurance, and adjunctive general services have 0%-50% coinsurance. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Insulin has a copay between $0 and $35, and other Medicare Part B drugs have a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs also have a 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 is covered by the Blue Cross Medicare Advantage Complete (PPO) plan, with a 20% to 25% coinsurance for Durable Medical Equipment (DME) and a 15% coinsurance for Diabetic Therapeutic Shoes/Inserts; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. This plan requires authorization for the benefits and has preferred vendors/manufacturers for DME.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for Diagnostic Procedures/Tests with a copay between $0 and $10, but Lab Services are not covered. Outpatient X-Ray Services have a $5 copay, while Diagnostic Radiological Services have a copay up to $50 and Therapeutic Radiological Services have 10% coinsurance.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, and Pulmonary Rehabilitation Services. 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Blue Cross Medicare Advantage Complete (PPO) plan covers acupuncture with a $20 copay and also covers Over-the-Counter (OTC) items up to $50 every three months. This plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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