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Blue Medicare Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Advantage (PPO) in 2026, please refer to our full plan details page.
Blue Medicare Advantage (PPO) is a PPO plan offered by Blue Cross Blue Shield of Kansas available for enrollment in 2025 to people living in NE Region. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Blue Medicare Advantage (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 Medicare Advantage (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 Medicare Advantage (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 a $300.00 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 $9200.00 (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 $9200.00 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 Medicare Advantage (PPO) plan features an annual prescription drug deductible of $300. You can save on medication costs with no copay for Tier 1 preferred generics and Tier 2 generics when filled through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options are also available, with copays ranging from $5 to $10 for Tier 1 and $10 to $20 for Tier 2 drugs. For higher-tier medications, costs are structured around coinsurance percentages rather than flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance at preferred locations and 25% at standard locations. Tier 4 non-preferred drugs require up to 33% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The Blue Medicare Advantage (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, urgent care, and emergency room visits, members pay straightforward copays, such as a $40 specialist copay and a $130 emergency copay, with no coinsurance. Inpatient hospital stays require a $350 copay for days 1 to 6, followed by no copay for days 7 through 90. Supplemental benefits include preventive dental care and home infusion services with no copay or coinsurance, alongside a quarterly allowance for over-the-counter items. Routine vision and hearing exams are covered with low copays and no deductibles, while comprehensive dental services require no copay and a 50% coinsurance. Durable medical equipment and dialysis services are also covered with no copay, requiring only standard coinsurance.
Inpatient Hospital See details
Blue Medicare Advantage (PPO) inpatient hospital care is partially covered with no coinsurance, requiring a $350 copay for days 1 to 6 and no copay for days 7 to 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Medicare Advantage (PPO) covers outpatient hospital, observation, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse sessions incur a $40 copay with no coinsurance, while outpatient blood services are fully covered with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Blue Medicare Advantage (PPO) with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Blue Medicare Advantage (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, while routine transportation services are not covered.
Emergency Services See details
Emergency services under the Blue Medicare Advantage (PPO) plan are covered with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services are covered with a $35 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with a $130 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Blue Medicare Advantage (PPO) covers primary care visits with no copay and no coinsurance, while specialist, therapy, and mental health services require a $40 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance (routine and other chiropractic care are not covered), while podiatry services are not covered.
Preventive Services See details
Blue Medicare Advantage (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management, with no copay and no coinsurance. Additional preventive benefits are partially covered, including memory fitness with no copay and no coinsurance, and remote access technologies with a $10 copay and no coinsurance, while services like health education and in-home safety assessments are not covered.
Hearing Services See details
Blue Medicare Advantage (PPO) provides partially covered hearing services, featuring a $45 copay and no coinsurance for one routine hearing exam per year with no deductible. Prescription hearing aids are covered with no coinsurance and copays ranging from $295 to $1,495 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision Services are covered by Blue Medicare Advantage (PPO) with no deductibles or coinsurance, featuring a $0 to $45 copay for annual eye exams and a $45 copay for contact lenses, subject to annual maximum limits of $85 and $250 respectively. The benefit is partially covered, as eyewear upgrades are not covered.
Dental Services See details
Blue Medicare Advantage (PPO) dental services are partially covered up to a $2,500 annual limit, with a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care. Comprehensive services require no copay and 50% coinsurance, though other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Blue Medicare Advantage (PPO) with no copay, though associated Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance. Covered Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance, which does not apply to the plan deductible.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Advantage (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Advantage (PPO) covers medical equipment with no copays, though coinsurance is required for most items. Durable medical equipment incurs a 15% coinsurance, prosthetic devices, medical supplies, and diabetic shoes carry a 20% coinsurance, and diabetic supplies require prior authorization with coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Blue Medicare Advantage (PPO) partially covers diagnostic and radiological services, offering diagnostic services with no copay or coinsurance, though lab services and diagnostic procedures are not covered. Prior authorization is required for radiological services, where diagnostic radiological services require a minimum $40 copay with no coinsurance, therapeutic radiological services require a minimum 20% coinsurance and a copay, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Blue Medicare Advantage (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Blue Medicare Advantage (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Blue Medicare Advantage (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Blue Medicare Advantage (PPO), as acupuncture is not covered. Covered benefits include chronic illness meals and over-the-counter (OTC) items up to $47.50 every three months, both offered with no copay and no coinsurance.
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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.
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