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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 2025, 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 2025.
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 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 $8900.00 (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 $8900.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies and no copay with preferred mail order. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Blue Medicare Advantage (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll find a $330 copay for inpatient hospital stays for the first six days, with no copay for subsequent days. Outpatient services have a $275 copay, and primary care visits have a $5 copay. This plan includes coverage for emergency services, hearing, vision, and dental services. You can expect copays for services like hearing exams ($45), eye exams (between $0 and $45), and dental services ($40). The plan also covers prescription hearing aids and offers an over-the-counter benefit up to $35 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $330 copay for days 1-6, and no copay for days 7-90, and no coinsurance. Additional days for Inpatient Hospital-Acute have no copay, and no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $330 copay for days 1-6, and no copay for days 7-90, and no coinsurance. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Blue Medicare Advantage (PPO) plan. Outpatient hospital services, observation services, and ambulatory surgical center services have a $275 copay, while individual and group sessions for outpatient substance abuse have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Medicare Advantage (PPO) plan. This benefit has a $30 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Medicare Advantage (PPO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Blue Medicare Advantage (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $30 copay; both have no coinsurance. Worldwide Emergency Coverage has a $125 copay, and a maximum benefit of $50,000. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue Medicare Advantage (PPO) plan covers primary care physician services with a $5 copay, and chiropractic services with a $20 copay. Occupational Therapy Services have a $40 copay, while Physician Specialist Services have a $40 copay. Mental Health Specialty Services, Other Health Care Professional, and Psychiatric Services have a $40 copay, and Physical Therapy and Speech-Language Pathology Services have a $40 copay. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
Preventive services, including Medicare-covered services, are covered. Annual physical exams are covered. Additional preventive services include no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) have a $10 copay.
Hearing Services See details
Hearing services include hearing exams with a $45 copay. Prescription hearing aids are covered with a copay between $295 and $1495, but inner ear, outer ear, and over-the-ear hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $45, and eyewear with a $45 copay. Eyewear benefits include a combined maximum of $250 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $40 copay, while other dental services have a $2,500 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment are covered, with a limited number of visits per year. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 50% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Advantage (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 15% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, with a minimum copay of $40, and Therapeutic Radiological Services have a coinsurance of at most 20%, with a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Advantage (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue Medicare Advantage (PPO) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. The plan mentions copays for some services, but does not specify the amount.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Advantage (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Blue Medicare Advantage (PPO) plan covers Over-the-Counter (OTC) items, offering a maximum benefit of $35.00 every three months, including nicotine replacement therapy and Naloxone coverage. This plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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. The plan also offers a meal benefit for chronic illness.
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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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