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Blue Cross Medicare Advantage Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Core (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 Core (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Core (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 Core (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 Core (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 Core (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.00. 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 $350.00 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 $10000.00 (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 $10000.00 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 Core (PPO) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay the following costs. For preferred generic drugs, you will pay no copay at a standard or preferred mail pharmacy and $5 at a standard mail pharmacy. For standard generic drugs, you will pay 25% coinsurance. For preferred brand drugs, you will pay 45% coinsurance at a standard or preferred mail pharmacy and 47% coinsurance at a standard mail pharmacy. For non-preferred drugs, you will pay 28% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Core (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay of $375, and outpatient services with varying copays. You'll have no copay for primary care visits, but specialist visits have a $40 copay. This plan also covers preventive services, hearing exams, and vision services, including routine eye exams with no copay and eyewear up to a $125 annual maximum. Dental services are included with a $2,000 annual maximum benefit, and there is a $50 copay for Medicare-covered dental.
Inpatient Hospital See details
Inpatient Hospital services for Blue Cross Medicare Advantage Core (PPO) have a copay of $375 per admission for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services have a copay of $375 for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay of $20.00 - $415.00, Observation Services have a copay of $415.00, Ambulatory Surgical Center (ASC) Services have a copay of $365.00, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Core (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Core (PPO) plan. Both ground and air ambulance services have a $315 copay, with no coinsurance, while 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 Core (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Transportation has a 20% coinsurance, and Worldwide Emergency Coverage, as well as Worldwide Urgent Coverage, have a $125 copay.
Primary Care See details
The Blue Cross Medicare Advantage Core (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, mental health specialty services with a $20 copay for individual and group sessions, podiatry services with a $40 copay for covered services and routine foot care, other health care professional services with a copay between $20 and $30, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, fitness benefits, remote access technologies, counseling services, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Home and Bathroom Safety Devices and Modifications are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, with routine hearing exams covered for 2 visits every year. Prescription hearing aids are covered with a copay between $699 and $999, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Blue Cross Medicare Advantage Core (PPO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum benefit of $125 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Core (PPO) plan covers dental services, including Medicare dental services with a $50 copay, and other dental services with a $2,000 maximum benefit per year. This plan covers oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and adjunctive general services. However, restorative services, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a copay between $0 and $35, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Core (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Blue Cross Medicare Advantage Core (PPO) plan, including Durable Medical Equipment (DME) with a 20-35% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $30, diagnostic radiological services with a copay up to $150, and outpatient X-ray services with a $15 copay. Therapeutic Radiological Services have a coinsurance of 20%, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Core (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and copay information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Core (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Blue Cross Medicare Advantage Core (PPO) plan covers acupuncture with a $20 copay, and also covers over-the-counter items, offering a maximum of $50 every three months. The plan also provides a meal benefit for chronic illnesses. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other 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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