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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 2026, 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 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 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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.10. You must continue to pay paying your reduced 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 $615.00 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 $10100.00 (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 $10100.00 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 features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic and Tier 2 generic medications have no copay when filled at a standard pharmacy or through preferred mail order. If you choose standard mail order for these generic tiers, you will pay a $10 copay for a one-month supply and a $20 copay for two- or three-month supplies. For brand-name and specialty prescriptions, costs are based on coinsurance percentages. Tier 3 preferred brand drugs require a 25% coinsurance for all pharmacy and mail order options, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Tier 4 non-preferred drugs carry a 43% coinsurance at standard pharmacies and preferred mail order, which increases to 45% coinsurance for standard mail order.
Additional Benefits
The Blue Cross Medicare Advantage Core (PPO) plan offers affordable essential coverage featuring no copay and no coinsurance for primary care visits, routine preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $550 daily copay for the first five days, followed by no copay for days six through ninety. Emergency room visits require a $130 copay with no coinsurance, which is waived if you are admitted, while urgently needed care has a $45 copay. Specialist visits require copays ranging from $15 to $55, while routine dental, vision, and hearing exams are covered with no copay or coinsurance. Prescription hearing aids carry copays between $699 and $999, and durable medical equipment requires no copay but carries a 20% to 35% coinsurance. Please note that this plan does not cover cardiac rehabilitation services or diabetic supplies, but it provides allowances for eyewear and dental care up to annual limits.
Inpatient Hospital See details
Blue Cross Medicare Advantage Core (PPO) covers inpatient acute hospital stays with no coinsurance and a $550 daily copay for days 1 to 5, and inpatient psychiatric care with no coinsurance and a $465 daily copay for days 1 to 5. Both benefits feature no copay for days 6 to 90, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Core (PPO) covers outpatient services with no coinsurance, featuring outpatient hospital copays ranging from $20 to $500 and ambulatory surgical center copays of $400. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Core (PPO) plan with a $55 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Core (PPO) covers ground and air ambulance services with a $500 copay and no coinsurance, though prior authorization is required. Regarding transportation, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Core (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency and urgent care carry a $130 copay with no coinsurance, and worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Primary Care benefits under the Blue Cross Medicare Advantage Core (PPO) plan are covered with no coinsurance, featuring no copay for primary care physician visits and copays ranging from $15 to $55 for specialists, physical therapy, and mental health services. Chiropractic services are partially covered, offering a $15 copay for up to 12 routine visits per year while other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Blue Cross Medicare Advantage Core (PPO) with no copay and no coinsurance for covered options like annual physicals, health education, counseling, and kidney disease education. Excluded services include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and home safety modifications.
Hearing Services See details
Hearing services are covered by Blue Cross Medicare Advantage Core (PPO), offering routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, but inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Core (PPO) partially covers vision services with no copays, no coinsurance, and no deductibles for covered benefits. This includes up to two routine eye exams per year and eyewear up to a combined $100 annual maximum, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Core (PPO) offers partially covered dental services with a $1,000 annual combined maximum, featuring no copay and no coinsurance for cleanings, fluoride, x-rays, periodontics, and adjunctive general services. Medicare-covered dental services require a $50 copay and oral exams require a $10 copay, both with no coinsurance. Restorative services, endodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Core (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs feature a $0 to $35 copay and no coinsurance, while Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Core (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Core (PPO) partially covers medical equipment with no copays, featuring a 20% to 35% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for several of these benefits, and diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under Blue Cross Medicare Advantage Core (PPO) because lab services are not covered. Covered diagnostic procedures require prior authorization, no coinsurance, and a copay between $0 and $50, while radiological services require prior authorization with costs ranging from no copay for diagnostic radiology, a $25 copay for X-rays, and 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Core (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Blue Cross Medicare Advantage Core (PPO) plan. In practice, none of the associated sub-services, including pulmonary, intensive cardiac, and supervised exercise therapy (SET) for peripheral artery disease (PAD), are covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Core (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 standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by Blue Cross Medicare Advantage Core (PPO) include acupuncture for a $15 copay and no coinsurance, limited to 12 treatments per year with prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, with over-the-counter items limited to $50 every six months.
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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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