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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 SC 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 $10.00. 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 drug deductible of $300. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail-order services, you will pay a low copay of $5 for Tier 1 and $10 for Tier 2 for a one-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require 24% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs range from 31% to 33% coinsurance. Specialty Tier 5 drugs carry a 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Medicare Advantage (PPO) plan offers comprehensive coverage for core medical services with predictable copays and no coinsurance for most major treatments. You will pay no copay for preventive services and home health care, a low $5 copay for primary care visits, and a $40 copay for specialist visits. If you require hospital care, outpatient services carry a $300 copay, while inpatient stays require a $400 daily copay for the first 6 days. For supplemental care, the plan features no copay for preventive dental and routine vision exams, though comprehensive dental services require a 50% coinsurance up to a $2,500 annual limit. Hearing exams carry a $45 copay, while covered hearing aids require a copay between $295 and $1,495 with no coinsurance. Additionally, medical equipment and dialysis services are available with no copay and 15% to 20% coinsurance.
Inpatient Hospital See details
Blue Medicare Advantage (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $400 copay for days 1 through 6 of acute care (no copay for days 7 and beyond) and a $350 copay for days 1 through 6 of psychiatric care (no copay for days 7 through 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Medicare Advantage (PPO) covers outpatient services with no coinsurance, featuring a $300 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse sessions have a $40 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are 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, and this copay is not waived if you are admitted to the hospital. While transportation services are technically covered, some services are not covered in practice, including trips to plan-approved or any health-related locations.
Emergency Services See details
Blue Medicare Advantage (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 limit with a $130 copay and no coinsurance, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Blue Medicare Advantage (PPO) covers primary care visits for a $5 copay and no coinsurance, while specialist visits, therapies, and mental health services require a $40 copay and no coinsurance. Opioid treatment is covered with a $10 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services under Blue Medicare Advantage (PPO) are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. While memory fitness is covered and remote access technologies require a $10 copay, several supplemental benefits—including health education, personal emergency response systems, in-home safety assessments, and nutritional benefits—are not covered.
Hearing Services See details
Blue Medicare Advantage (PPO) hearing services are partially covered, offering routine exams and fitting evaluations for a $45 copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295 to $1,495, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Medicare Advantage (PPO) provides partially covered vision services with no deductibles and no coinsurance, although eyewear upgrades are not covered. Eye exams feature no copay for routine visits and up to a $45 copay for other exams, while eyewear has a $45 copay for contact lenses and no copay for eyeglasses, frames, or lenses up to annual limits.
Dental Services See details
Blue Medicare Advantage (PPO) offers partially covered dental services with an annual maximum benefit of $2,500, requiring 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, while other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Medicare Advantage (PPO) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance to 20% coinsurance.
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, featuring a 15% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies require prior authorization and carry between no coinsurance and 20% coinsurance.
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 diagnostic procedures, tests, and lab services are not covered. Radiological services require prior authorization, with diagnostic radiological services carrying a minimum $40 copay and no coinsurance, and therapeutic radiological services requiring a minimum 20% coinsurance and a copay. Outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Blue Medicare Advantage (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Blue Medicare Advantage (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Blue Medicare Advantage (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. Covered stays incur a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare limit are not covered.
Other Services See details
Blue Medicare Advantage (PPO) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $32.50 every three months, and the meal benefit has no maximum limit.
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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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