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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 $105.00. 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 a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different costs depending on the drug tier and pharmacy. For example, at a standard pharmacy, you'll have no copay for preferred generic drugs, 25% coinsurance for standard generic drugs, and 42% coinsurance for preferred brand drugs. 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 comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with copays varying based on the specific service, such as $140 for emergency services and $20 for mental health services. It also includes vision and hearing coverage, with routine eye exams and hearing exams covered, and coverage for prescription hearing aids. Additionally, this plan provides coverage for dental services, including oral exams, x-rays, and cleanings, with coinsurance for restorative services. The plan also covers home health services with no copay, as well as skilled nursing facility care with a copay after the first 20 days. Other benefits include ambulance services, and coverage for medical equipment and home infusion services.
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, and the copay for a Medicare-covered stay is $250. Inpatient Hospital Psychiatric has a copay of $250 for a Medicare-covered stay. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days for Inpatient Hospital Psychiatric and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $10 and $175, observation services with a $175 copay, ambulatory surgical center services with a $150 copay, and outpatient substance abuse services with a $20 copay per session. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Choice (PPO) plan, but requires prior authorization. This benefit has a $55 copay.
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, with no coinsurance, but 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 under the Blue Cross Medicare Advantage Choice (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $40 copay; Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a 20% coinsurance for Worldwide Emergency Transportation.
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 $40 copay), Physician Specialist Services (with a $40 copay), and Mental Health Specialty Services (with a $20 copay for individual and group sessions). This plan also covers Physical Therapy and Speech-Language Pathology Services (with a $40 copay), Other Health Care Professional (with a $20 copay), Psychiatric Services (with a $20 copay for individual and group sessions), and Opioid Treatment Program Services (with a $40 copay). However, Routine Chiropractic Care and Additional Telehealth Benefits are not covered, and Podiatry Services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers preventive services including annual physical exams, health education, kidney disease education services, and other preventive services. Additional services include fitness benefits and counseling services. In-home safety assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams are limited to 2 visits every year. Prescription hearing aids are covered with a copay between $599 and $899, while 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
Vision services are covered, including routine eye exams, with two visits allowed per year, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $150 per year, and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Choice (PPO) plan covers dental services including oral exams with a $30 copay, x-rays, cleaning, and fluoride treatments. Restorative services have a 30% to 50% coinsurance, while endodontics, removable prosthodontics, implant services, fixed prosthodontics, 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 by the Blue Cross Medicare Advantage Choice (PPO) plan 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 Choice (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20-30% coinsurance and Prosthetics/Medical Supplies with a coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 15% coinsurance. The plan does not cover DME for use outside the home, nor does it cover Diabetic Supplies.
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 up to $100, Therapeutic Radiological Services have a 15% coinsurance, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Choice (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by the Blue Cross Medicare Advantage Choice (PPO) plan. Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services and Additional Cardiac Rehabilitation Services have a copay, while 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) benefits are covered by the Blue Cross Medicare Advantage Choice (PPO) plan, but require prior authorization. For days 1-20, there is no copay, while for days 21-100, the copay is $214.
Other Services See details
Other Services includes acupuncture with a $20 copay, and over-the-counter (OTC) items with a maximum benefit of $50 every three months. The plan also covers meal benefits for chronic illnesses, but does not cover 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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