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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 51 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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.80. 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 $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 $7900.00 (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 $7900.00 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 you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will have no copay at a standard pharmacy or through preferred mail order, and a $5 copay through standard mail order. For other tiers, you will pay coinsurance that ranges from 25% to 47% depending on the drug and pharmacy. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Core (PPO) plan offers a range of benefits, including inpatient hospital care with a $350 copay, outpatient services with varying copays, and emergency services with a $125 copay. Preventive services and primary care, like primary care physician visits, are covered with copays ranging from $20 to $45, and there are no copays for routine eye exams. Vision includes eyewear with a combined maximum benefit of $275 per year. This plan also covers hearing services, including hearing exams, and prescription hearing aids with a copay, as well as dental services with a $50 copay for Medicare dental services and a $2,000 maximum benefit for other dental services. Additional benefits include ambulance services with a $290 copay, home health services with no copay, and durable medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you will pay a $350 copay for days 1-5, and no copay for days 6-90, while inpatient psychiatric care has a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered. Outpatient hospital services have a copay of $20 to $400, observation services have a $400 copay, and ambulatory surgical center services have a $300 copay. Outpatient substance abuse services, including individual and group sessions, are covered with a copay of $20. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Core (PPO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Blue Cross Medicare Advantage Core (PPO) plan. Ground and Air Ambulance Services have a $290 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $125 copay, and no coinsurance. Urgently Needed Services are covered, with a $45 copay, and no coinsurance. Worldwide Emergency Services are covered, with a $125 copay for Worldwide Urgent Coverage and Worldwide Emergency Coverage, and a 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Blue Cross Medicare Advantage Core (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $45 copay, mental health specialty services with a $20 copay for individual and group sessions, podiatry services with a $45 copay for routine foot care and other Medicare-covered services, other health care professional services with a $20 copay, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $45 copay, additional telehealth benefits, and opioid treatment program services with a $45 copay. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive services include Medicare-covered services, an annual physical exam, and additional preventive services, all of which are covered. This plan also covers health education, remote access technologies, counseling services, and fitness benefits, but does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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, home and bathroom safety devices and modifications. Additionally, the plan covers kidney disease education services and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following welcome visits.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered for up to two visits every year, and fitting/evaluation for hearing aids are unlimited. Prescription hearing aids are covered with a copay between $699 and $999, but inner ear, outer ear, and over the ear prescription 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 for up to 2 visits every year and eyewear with a combined maximum plan benefit of $275.00 every year for both in-network and out-of-network services. Contact lenses, eyeglass lenses and frames are covered with no copay, but upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Core (PPO) plan covers Medicare Dental Services with a $50 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, with limits on the number of visits. Restorative services, endodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Adjunctive General Services and Periodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. 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 for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 20-35% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $150, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific costs are not described in this snippet. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
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 per day. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Under the Blue Cross Medicare Advantage Core (PPO) plan, acupuncture is covered with a $20 copay, but is limited to 12 treatments per year and requires prior authorization. Over-the-counter items are covered with a maximum benefit coverage amount of $60 every three months, and the plan offers nicotine replacement therapy and Naloxone coverage. The plan also offers a meal benefit for chronic illnesses, and other services like Early and Periodic Screening, Diagnostic, and Treatment 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.
* 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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