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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 2025, 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 2025.
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 $37.00. 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 $8000.00 (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 $8000.00 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $0 copay when using preferred mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Blue Medicare Advantage Comprehensive (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, while many outpatient services, including primary care and preventive services, have no copay. The plan also includes coverage for hearing, vision, and dental services, each with specific copays and limitations. This plan covers emergency services, ambulance, and transportation services with copays, as well as home health and dialysis services with no copay or coinsurance. Other benefits include coverage for medical equipment, and home infusion services, while some services like cardiac rehabilitation and certain dental procedures have limitations.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $295 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute have no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $250 copay, while outpatient substance abuse individual and group sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Medicare Advantage Comprehensive (PPO) plan with a $25 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Blue Medicare Advantage Comprehensive (PPO) plan. Ground and Air Ambulance Services have a $300 copay, and there is no coinsurance; however, 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 Comprehensive (PPO) plan. Emergency Services has a $120 copay, while Urgently Needed Services has a $25 copay; both have no coinsurance. Worldwide Emergency Coverage has a $120 copay and no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue Medicare Advantage Comprehensive (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $40 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, and opioid treatment program services have a $5 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services. Medicare-covered Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit have no copay. However, services such as Health Education, In-Home Safety Assessments, and other services are not covered.
Hearing Services See details
Hearing Services are covered, including hearing exams with a $35 copay, fitting and evaluation for hearing aids, and prescription hearing aids with a copay between $295 and $1495, however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Routine hearing exams are covered once per year.
Vision Services See details
The Blue Medicare Advantage Comprehensive (PPO) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with a $35 copay. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum of $200 every year. Upgrades are not covered.
Dental Services See details
Dental Services include a $35 copay for Medicare Dental Services. Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered, but have a limited number of visits per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. This plan has a maximum benefit coverage of $3,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
The Blue Medicare Advantage Comprehensive (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Blue Medicare Advantage Comprehensive (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay, and Diabetic Supplies have between 0% and 20% coinsurance. Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic Radiological Services have a copay of at least $35.00, up to $250.00, while Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Advantage Comprehensive (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 Comprehensive (PPO) plan. Although the plan states that Cardiac Rehabilitation Services are covered, the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Advantage Comprehensive (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
The Blue Medicare Advantage Comprehensive (PPO) 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. Over-the-counter items are covered up to $87.50 every three months, and the plan offers a meal benefit for chronic illnesses.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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