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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.
Blue Cross Medicare Advantage Comfort (PPO) is a PPO plan offered by Aware Integrated, Inc. available for enrollment in 2025 to people living in 40 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 $62.10. 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 $550.00 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 $6450.00 (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 $6450.00 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:
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Drug Coverage
The Blue Cross Medicare Advantage Comfort (PPO) plan features an annual drug deductible of $550. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled through standard pharmacies or preferred mail order. If you choose standard mail order for these generic tiers, costs are a $10 copay for a one-month supply and a $20 copay for two- or three-month supplies. For Tier 3 preferred brand drugs, there is a flat 25% coinsurance across standard pharmacies and mail order options. Tier 4 non-preferred drugs carry a 43% coinsurance at standard pharmacies and preferred mail, or 45% coinsurance through standard mail order. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply across all available standard pharmacy and mail order channels.
Additional Benefits
The Blue Cross Medicare Advantage Comfort (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and routine preventive services. Specialist visits require a $55 copay, while inpatient hospital stays carry a $350 daily copay for days 1 through 5 and no copay for days 6 through 90. Outpatient hospital services are covered with no coinsurance and copays ranging from $20 to $400 depending on the care received. Members also receive robust supplemental coverage, including routine dental care with no copay up to a $1,250 annual limit and comprehensive dental options with coinsurance between 0% and 70%. Routine hearing and vision exams have no copay, with additional allowances provided for glasses, contacts, and prescription hearing aids. Furthermore, emergency services feature a $130 copay, while home health services and over-the-counter items are available with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Blue Cross Medicare Advantage Comfort (PPO) with no coinsurance, featuring a copay of $350 per day for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $20 to $400 copay, observation services with a $400 copay per stay, and ambulatory surgical center services with a $325 copay. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
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
Ambulance and transportation services are partially covered under the Blue Cross Medicare Advantage Comfort (PPO) plan. Medicare-covered ground and air ambulance services require prior authorization and carry a $300 copay with no coinsurance, while transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers emergency services with a $130 copay and no coinsurance (waived if admitted to the hospital within 24 hours), and urgently needed services with a $45 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay and no coinsurance, while worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Blue Cross Medicare Advantage Comfort (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Other services like physical therapy and mental health sessions require copays between $15 and $55 with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Comfort (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and other preventive screenings. Additional preventive services are partially covered, but in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, 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 are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Comfort (PPO) offers partially covered hearing services, including routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $599.00 to $899.00, though OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Blue Cross Medicare Advantage Comfort (PPO) provides partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include up to two routine eye exams per year and a $125 annual combined allowance for contacts and eyeglasses, while other eye exam services and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers dental services, offering Medicare-covered dental at a $30 copay and no coinsurance, alongside preventive care with no copay and no coinsurance up to a $1,250 annual limit. Comprehensive dental is partially covered with no copay and coinsurance ranging from 0% to 70%, though implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Comfort (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin drugs require a $0 to $35 copay 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 coinsurance ranges from 20% to 35% and prior authorization is required for some items. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Comfort (PPO) partially covers diagnostic and radiological services, as lab services are not covered. Diagnostic procedures and tests require no coinsurance and a copay of up to $30, while diagnostic radiological services have no copay and no coinsurance. Outpatient X-rays require a $10 copay along with coinsurance, and therapeutic radiological services require both a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Comfort (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Comfort (PPO) covers some cardiac rehabilitation services with no coinsurance and a copay, but prior authorization is required. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Comfort (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 while a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Blue Cross Medicare Advantage Comfort (PPO), which includes acupuncture for a $15.00 copay and no coinsurance, as well as over-the-counter items and chronic illness meals for no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services and other additional services are not covered.
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