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Blue Medicare Advantage Comprehensive (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage Comprehensive (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 Comprehensive (PPO) in 2026, please refer to our full plan details page.
Blue Medicare Advantage Comprehensive (PPO) is a PPO plan offered by Blue Cross Blue Shield of Kansas available for enrollment in 2025 to people living in All 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 Comprehensive (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 Comprehensive (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 Comprehensive (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $8500.00 (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 $8500.00 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 Comprehensive (PPO) plan features an annual drug deductible of $300. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using a preferred pharmacy or preferred mail order service. Standard pharmacies and standard mail order services charge copays ranging from $5 to $10 for Tier 1 and $10 to $20 for Tier 2 drugs depending on the supply. For brand-name and specialty drugs, your costs are determined by coinsurance percentages. Tier 3 preferred brands cost 24% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs require 31% or 33% coinsurance respectively. Tier 5 specialty drugs have a 29% coinsurance rate for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Medicare Advantage Comprehensive (PPO) plan offers robust medical coverage with no copays or coinsurance for primary care visits, home health services, and routine preventive care. For more intensive medical needs, members pay a $300 daily copay for the first six days of inpatient hospital stays and a $250 copay for outpatient hospital services, both with no coinsurance. Emergency room visits require a $130 copay, which is waived if admitted, while specialist visits carry a $35 copay. This plan also features strong supplemental benefits, including a dental allowance of up to $3,000 annually and routine vision exams with no copay. Routine hearing exams require a $35 copay, while prescription hearing aids have copays ranging from $295 to $1,495. Additionally, members pay no copay and no coinsurance for quarterly over-the-counter item benefits up to $87.50, while durable medical equipment requires no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue Medicare Advantage Comprehensive (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a $300 daily copay for days 1 to 6, followed by no copay for days 7 to 90. While unlimited additional acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Medicare Advantage Comprehensive (PPO) covers outpatient services with no coinsurance, featuring a $250 copay for ambulatory surgical center, outpatient hospital, and daily observation services. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by the Blue Medicare Advantage Comprehensive (PPO) plan with a $25.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Blue Medicare Advantage Comprehensive (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, which is not waived if you are admitted to the hospital. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Blue Medicare Advantage Comprehensive (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $30 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 Comprehensive (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Additional benefits like physical therapy, occupational therapy, and psychiatric services require a $40 copay and no coinsurance, while chiropractic care is only partially covered and podiatry services are not covered.
Preventive Services See details
Blue Medicare Advantage Comprehensive (PPO) covers preventive services, including annual physicals, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Blue Medicare Advantage Comprehensive (PPO) covers hearing services, offering routine hearing exams for a $35 copay and no coinsurance, and prescription hearing aids for a $295 to $1,495 copay and no coinsurance. The benefit is partially covered because OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Blue Medicare Advantage Comprehensive (PPO) with no deductibles and no coinsurance. Eye exams range from no copay for routine visits to a $35 copay for other exams, while eyewear coverage includes a $35 copay for contact lenses up to a $200 annual limit, though upgrades are not covered.
Dental Services See details
Blue Medicare Advantage Comprehensive (PPO) offers partially covered dental services with an annual maximum benefit of $3,000 for both in-network and out-of-network care. Medicare-covered dental services have a $35 copay and no coinsurance, while other covered preventive and comprehensive services require no copay and no coinsurance, though other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Medicare Advantage Comprehensive (PPO) covers Home Infusion bundled Services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance. Part B insulin is also covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Medicare Advantage Comprehensive (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Advantage Comprehensive (PPO) covers medical equipment with no copays, including durable medical equipment, prosthetics, and medical supplies which carry a 20% coinsurance. Covered diabetic equipment requires prior authorization and has no copay, with 20% coinsurance for therapeutic shoes and inserts, and no coinsurance to 20% coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Blue Medicare Advantage Comprehensive (PPO) partially covers diagnostic and radiological services, offering diagnostic services with no copay or coinsurance, diagnostic radiological services with a minimum $35 copay, and therapeutic radiological services with a 20% minimum coinsurance. Prior authorization is required for radiological services, while diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by Blue Medicare Advantage Comprehensive (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Blue Medicare Advantage Comprehensive (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, but standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Blue Medicare Advantage Comprehensive (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Blue Medicare Advantage Comprehensive (PPO) provides partially covered Other Services, which exclude acupuncture. Covered benefits include a chronic illness meal benefit and over-the-counter items with a maximum benefit of $87.50 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.
* 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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