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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 2026, 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 4.5 out of 5 stars in 2026.
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 $108.70. 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 $400.00 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 $5950.00 (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 $5950.00 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 features an annual drug deductible of $400. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using standard pharmacies or preferred mail order services for up to a three-month supply. If you choose standard mail order for these generic drugs, copays range from $10 for a one-month supply to $20 for a two- or three-month supply. Tier 3 preferred brand drugs require a 25% coinsurance across standard pharmacies and mail order options. Tier 4 non-preferred drugs carry a 44% coinsurance at standard pharmacies and preferred mail order, which increases to 50% for standard mail order. Specialty drugs in Tier 5 are covered with a 28% coinsurance for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Choice (PPO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits and covered preventive services. For specialized care, members pay a $40 copay for specialists and a $400 copay per stay for inpatient hospital services with no coinsurance. Emergency room visits require a $150 copay, while urgent care services are available for a $40 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, such as routine vision and hearing exams with no copay and no coinsurance, plus a $200 annual eyewear allowance. Preventive dental care features no copay, while comprehensive dental services are covered up to a $2,000 yearly limit with coinsurance ranging from 0% to 50%. Additionally, home health services are provided with no copay, and skilled nursing facility care starts with no copay for the first 20 days of your stay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Blue Cross Medicare Advantage Choice (PPO) with no coinsurance and a $400 copay per stay for Medicare-covered acute and psychiatric care. Upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered under this plan.
Outpatient Services See details
Blue Cross Medicare Advantage Choice (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $10 to $300, while observation services require a $300 copay per stay. Ambulatory surgical center services have a $250 copay and no coinsurance, outpatient substance abuse sessions carry a $20 copay, and outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Choice (PPO) plan for a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, requiring prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Cross Medicare Advantage Choice (PPO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent care incur a $150 copay with no coinsurance, and worldwide emergency transportation requires a 20% coinsurance with no copay.
Primary Care See details
Blue Cross Medicare Advantage Choice (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $40 copay and no coinsurance. Mental health, psychiatric, and other healthcare professional services feature a $20 copay and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Blue Cross Medicare Advantage Choice (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and diabetes self-management. While health education, counseling, and memory fitness are included, the plan does not cover several additional services, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, and home/bathroom safety devices.
Hearing Services See details
Hearing services are covered by Blue Cross Medicare Advantage Choice (PPO), offering routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $599 to $899, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Choice (PPO) provides partially covered vision services with no copays, no coinsurance, and no deductibles. This benefit includes up to two routine eye exams per year and a $200 annual allowance for eyewear, though upgrades and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Blue Cross Medicare Advantage Choice (PPO) up to a $2,000 yearly limit, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 0% to 50% coinsurance. Medicare-covered dental services require a $30 copay and no coinsurance, while other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $0.00 to $35.00 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Choice (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Choice (PPO) covers medical equipment with no copays, requiring a 20% to 30% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic equipment is only partially covered, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice (PPO) partially covers diagnostic and radiological services, excluding lab services from coverage. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $25, while radiological services require prior authorization and range from no copay for diagnostic radiology to a $10 copay plus coinsurance for X-rays and a copay with a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Blue Cross Medicare Advantage Choice (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Blue Cross Medicare Advantage Choice (PPO) with no coinsurance, though prior authorization is required. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, while covered sub-services require a copayment ranging from $30 to $35.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Choice (PPO) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per stay. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Blue Cross Medicare Advantage Choice (PPO) are partially covered, featuring acupuncture with a $20 copay and no coinsurance for up to 12 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter items are not covered under this plan.
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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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