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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 $120.70. 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 $5850.00 (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 $5850.00 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 a $400 annual drug deductible. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using standard pharmacies or preferred mail order services. 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 a two- or three-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 44% coinsurance, which increases to 50% for standard mail order. Specialty drugs in Tier 5 require a 28% coinsurance for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Choice (PPO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay for primary care visits, home health, and preventive care. Inpatient hospital stays require a $500 copay per stay, while specialist visits and outpatient therapies have a $50 copay, both with no coinsurance. Emergency care is covered with a $150 copay, and urgent care visits require a $40 copay. For specialty care, the plan provides dental benefits up to a $1,500 annual limit with no copay and coinsurance ranging from 0% to 50%. Routine vision and hearing exams are available with no copay or deductible, plus a $150 annual eyewear allowance and prescription hearing aid copays between $599 and $899. Additionally, members pay a $20 copay for covered acupuncture treatments and no copay for home infusion services.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice (PPO) covers inpatient acute and psychiatric hospital services with a $500 copay per stay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice (PPO) covers outpatient services with no coinsurance, featuring copays of $10.00 to $275.00 for outpatient hospital services and $250.00 for ambulatory surgical center visits. Outpatient substance abuse sessions have a $25.00 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Choice (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
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, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Choice (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency and urgent care require a $150 copay, and worldwide emergency transportation has a 20% coinsurance.
Primary Care See details
Blue Cross Medicare Advantage Choice (PPO) features primary care doctor visits with no copay and no coinsurance, while specialist, occupational, physical, and speech therapies require a $50 copay and no coinsurance. Mental health, psychiatric, and other professional services have copays of $20 to $25 and no coinsurance, whereas telehealth services range from a $0 to $50 copay with no coinsurance. Podiatry is not covered, and chiropractic services are partially covered with routine and other chiropractic care excluded.
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 training. While memory fitness, counseling, and health education are covered, the plan does not cover 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 benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and home or bathroom safety modifications.
Hearing Services See details
Hearing services are partially covered under the Blue Cross Medicare Advantage Choice (PPO) plan, offering routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids require a copay of $599 to $899 with no coinsurance, but 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) partially covers vision services with no copay, no coinsurance, and no deductible. This benefit includes up to two routine eye exams per year and a $150 annual allowance for eyewear, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice (PPO) partially covers dental services up to a $1,500 annual maximum for both in- and out-of-network care. Preventive care and comprehensive services feature no copay with coinsurance ranging from 0% to 50%, while Medicare-covered dental requires a $30 copay and no coinsurance. However, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services 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. Covered Medicare Part B insulin drugs have a $0 to $35 copay and no coinsurance, while chemotherapy and other Part B drugs require 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. Prior authorization is required for these services.
Medical Equipment See details
Blue Cross Medicare Advantage Choice (PPO) covers medical equipment with no copay, featuring a 20% to 30% coinsurance for durable medical equipment (DME) and a 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic equipment is partially covered under this plan, as diabetic supplies themselves are not covered.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice (PPO) partially covers diagnostic and radiological services, as lab services are not covered. Covered diagnostic procedures and tests have no coinsurance and a copay of $0 to $25, while radiological services require prior authorization and range from no copay for diagnostic imaging to a $10 copay for X-rays and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Blue Cross Medicare Advantage Choice (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to access these fully covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Medicare Advantage Choice (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Blue Cross Medicare Advantage Choice (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Blue Cross Medicare Advantage Choice (PPO), which offers acupuncture for a $20 copay and no coinsurance for up to 12 treatments per year with prior authorization, as well as chronic illness meal benefits with no copay and no coinsurance. Over-the-Counter (OTC) items are not covered under this plan.
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