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Blue Cross Medicare Advantage Comfort (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Comfort (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 Comfort (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Blue Cross Medicare Advantage Comfort (PPO) is a PPO plan offered by BCBSM, Inc. available for the 2026 plan year to people living in Eleven 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 Comfort (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 Comfort (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 Comfort (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.70. 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 $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4500.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $6250.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6250.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Comfort (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Comfort (PPO) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay at standard pharmacies or through preferred mail order for up to a three-month supply. Standard mail order for these generic tiers requires a $10 copay for a one-month supply and a $20 copay for a two- or three-month supply. Brand-name and specialty medications under this plan are covered via coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply. Tier 4 non-preferred drugs require a 43% coinsurance at standard pharmacies and preferred mail order, or a 45% coinsurance through standard mail order.
Additional Benefits
The Blue Cross Medicare Advantage Comfort (PPO) plan offers robust coverage for essential medical needs with predictable cost-sharing. Members enjoy no copays and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, there is no coinsurance and a $300 daily copay for the first five days, while specialist visits require a $50 copay and emergency room visits feature a $130 copay. This plan also includes valuable supplemental benefits with no deductibles, including routine dental, vision, and hearing exams all featuring no copays. Comprehensive dental services are covered with no copay and 0% to 60% coinsurance, while prescription hearing aids require a copay of $599 to $899. Additionally, skilled nursing facility stays offer no copay for the first 20 days, and over-the-counter items are covered with no copay up to thirty dollars every six months.
Inpatient Hospital See details
Blue Cross Medicare Advantage Comfort (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90. The benefit is partially covered, as unlimited additional acute days are included, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers outpatient services with no coinsurance, though copayments and prior authorizations apply to most care. Members will pay a $20 to $400 copay for outpatient hospital services, a $400 copay per stay for observation services, a $325 copay for ambulatory surgical center visits, and a $25 copay for substance abuse sessions, while outpatient blood services feature no copay or deductible.
Partial Hospitalization See details
Blue Cross Medicare Advantage Comfort (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, although prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers emergency services with a $130 copay (no coinsurance), which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $45 copay (no coinsurance). Worldwide emergency and urgent care are also covered with a $130 copay (no coinsurance), while worldwide emergency transportation is covered with a 20% coinsurance (no copay).
Primary Care See details
Blue Cross Medicare Advantage Comfort (PPO) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $50 copay and no coinsurance. Mental health, psychiatric, and telehealth services are covered with no coinsurance and copays ranging from $0 to $50, but podiatry is not covered and chiropractic services are only partially covered with routine and other chiropractic services excluded.
Preventive Services See details
Preventive Services are partially covered by Blue Cross Medicare Advantage Comfort (PPO) with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and kidney disease education. Non-covered services under this benefit include 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 smoking cessation, enhanced disease management, telemonitoring, and home/bathroom safety devices.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Comfort (PPO), offering up to two routine hearing exams per year and unlimited fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to two per year with no coinsurance and a copay of $599 to $899, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Comfort (PPO) partially covers vision services with no copay, no coinsurance, and no deductible. Covered services include up to two routine eye exams per year and a $125 annual combined limit for eyewear, though other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Comfort (PPO) dental services are partially covered up to a $1,750 annual limit, featuring no copay and no coinsurance for routine preventive care, and no copay with 0% to 60% coinsurance for comprehensive care. Medicare-covered dental requires a $30 copay and no coinsurance, while other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs have a copay of $0.00 to $35.00 and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Comfort (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Comfort (PPO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered benefits, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, feature no copay and a coinsurance ranging from 20% to 35%.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Comfort (PPO) diagnostic and radiological services are partially covered, as lab services are not covered. Covered diagnostic procedures and tests have no coinsurance and a $0 to $25 copay, while radiological services require prior authorization and range from no copay for diagnostic scans to a $10 copay for X-rays and 20% coinsurance for therapeutic services.
Home Health Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers select cardiac rehabilitation services with no coinsurance and copays ranging from $25 to $35, requiring prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Comfort (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Blue Cross Medicare Advantage Comfort (PPO), featuring acupuncture for a $15.00 copay and no coinsurance, up to 12 treatments per year with prior authorization. Over-the-counter items (up to $30.00 every six months) and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, while other miscellaneous services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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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