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Blue Cross Medicare Advantage Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice (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 Choice (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice (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 Choice (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 Choice (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 Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $96.00. 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 $5150.00 (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 $5150.00 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 Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Choice (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Choice (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan also covers a variety of services like primary care, hearing, vision, and dental, with specific copays and coverage limits for each. Preventive services are covered with no copay, and there is coverage for ambulance, emergency, and skilled nursing services with specific cost-sharing structures. Additional benefits include coverage for home health, dialysis, and medical equipment, subject to copays or coinsurance. The plan also provides coverage for other services such as acupuncture, over-the-counter items, and mental health services. However, it's important to note that certain services like additional hours of care, personal care, and some specialized treatments are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Blue Cross Medicare Advantage Choice (PPO) plan. For Inpatient Hospital-Acute, there is no copay for days 1-60. For Inpatient Hospital Psychiatric, and Additional Days for Inpatient Hospital Psychiatric, some services are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $10-$175, observation services with a $175 copay, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $15 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Choice (PPO) plan, but prior authorization is required. The plan has a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance; however, 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 Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $40 copay. Worldwide Emergency Transportation has a 20% coinsurance.
Primary Care See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $15 copay for individual and group sessions, podiatry services with a $35 copay for routine foot care, other health care professional services with a $20 copay, psychiatric services with a $15 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits, and opioid treatment program services with a $35 copay.
Preventive Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers preventive services, including no copay for Medicare-covered preventive services, annual physical exams, and additional preventive services. Additionally, the plan covers health education, fitness benefits for memory fitness, remote access technologies, counseling services, kidney disease education, and other preventive services such as glaucoma screenings and diabetes self-management training. However, in-home safety assessments, personal emergency response systems, and other services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams are covered for 2 visits every year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids have a copay between $599 and $899 per year, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers routine eye exams twice per year, and eyewear with a combined maximum of $200 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, but upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $30 copay, and other dental services with a $2,000 annual maximum. Oral exams are covered for 5 visits per year, while Dental X-Rays are covered for 10 per year; Prophylaxis (Cleaning) and Fluoride Treatment are each covered for 2 visits per year. Restorative Services have 30% - 50% coinsurance, Adjunctive General Services have 0% - 50% coinsurance, Endodontics, Prosthodontics (removable), Implant Services, Prosthodontics (fixed), and Oral and Maxillofacial Surgery have a 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. 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 by the Blue Cross Medicare Advantage Choice (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Blue Cross Medicare Advantage Choice (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 20% and 30%, and Prosthetic Devices have a 30% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 15% coinsurance, however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $25, and outpatient X-ray services with a $10 copay. Therapeutic Radiological Services have a coinsurance of at most 15%, and Diagnostic Radiological Services have a copay of at most $100. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan with no copay or 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 details on cost sharing are not provided. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Choice (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.
Other Services See details
The "Other Services" benefit covers acupuncture with a $20 copay per visit, and over-the-counter items with a maximum benefit of $50 every three months. The plan also offers a meal benefit for chronic illnesses, and covers nicotine replacement therapy and Naloxone as OTC benefits. The following services are not covered: 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, and Self-Directed Personal Assistance Services.
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