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Blue Medicare Advantage Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage Choice (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 Choice (PPO) in 2026, please refer to our full plan details page.
Blue Medicare Advantage Choice (PPO) is a PPO plan offered by Blue Cross Blue Shield of Kansas available for enrollment in 2025 to people living in All Regions. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Blue Medicare Advantage Choice (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 Choice (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 Choice (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 $5700.00 (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 $5700.00 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 Choice (PPO) plan features a $300 drug deductible and offers excellent savings on generic medications. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. If you choose standard pharmacies or standard mail-order options, these generic drugs cost between $5 and $20 depending on the tier and supply duration. Brand-name and specialty drugs are subject to coinsurance rates rather than flat copays under this plan. 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 medications in Tier 5 carry a 29% coinsurance rate for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Medicare Advantage Choice (PPO) plan offers robust healthcare coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, outpatient substance abuse sessions, and urgent care, members pay a low $30 copay with no coinsurance. Inpatient hospital stays require a $350 daily copay for the first six days and no copay thereafter, while emergency room visits carry a $150 copay that is waived if admitted. This plan also includes valuable dental, vision, and hearing benefits to help reduce out-of-pocket expenses. Routine dental cleanings and exams feature no copay, while dental services are covered up to a $3,000 annual limit. Additionally, members receive a $300 annual eyewear allowance and a $75 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Blue Medicare Advantage Choice (PPO) covers inpatient hospital acute and psychiatric stays with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Blue Medicare Advantage Choice (PPO) with no coinsurance, including a $300 copay for outpatient hospital and ambulatory surgical center services, and a $265 daily copay for observation services. Outpatient substance abuse sessions have a $30 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Medicare Advantage Choice (PPO) covers partial hospitalization services with a $30.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Blue Medicare Advantage Choice (PPO), with ground and air ambulance services requiring a $300 copay and no coinsurance. For transportation, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Blue Medicare Advantage Choice (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, 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 $150 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Blue Medicare Advantage Choice (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay, mental health services require a $30 copay, and psychiatric services require a $40 copay, all with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Blue Medicare Advantage Choice (PPO) preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, are covered with no copay and no coinsurance. Additional preventive benefits are partially covered, offering remote access technologies with no copay and no coinsurance, while services such as fitness benefits, health education, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
Blue Medicare Advantage Choice (PPO) covers hearing services, including one annual routine hearing exam for a $30 copay and no coinsurance, and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $295.00 to $1,495.00 for up to two aids per year, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Blue Medicare Advantage Choice (PPO) covers annual eye exams with no deductible, no coinsurance, and a copay of $0 to $30. Eyewear is partially covered with a $300 annual limit, featuring no coinsurance and a $30 copay for contact lenses, though eyewear upgrades are not covered.
Dental Services See details
Blue Medicare Advantage Choice (PPO) partially covers dental services up to a $3,000 annual maximum for both in-network and out-of-network care, requiring a $30 copay and no coinsurance for Medicare-covered dental. Other covered services like exams, cleanings, and restorative care have no copay and no coinsurance, but other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Medicare Advantage Choice (PPO) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy and other drugs carry between no coinsurance and 20% coinsurance. Covered Part B insulin has a $35 copay and between no coinsurance and 20% coinsurance, which does not count toward the plan-level deductible.
Dialysis Services See details
Blue Medicare Advantage Choice (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Advantage Choice (PPO) covers medical equipment with no copay, featuring a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts. Diabetic supplies are also covered with no copay and carry a coinsurance ranging from 0% (no coinsurance) to 20%, though prior authorization is required for diabetic equipment.
Diagnostic and Radiological Services See details
Blue Medicare Advantage Choice (PPO) partially covers diagnostic and radiological services, offering diagnostic services with no copay and no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Diagnostic radiological services require a minimum $30 copay and no coinsurance, while therapeutic radiological services require a copay and a 20% coinsurance; outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are fully covered under the Blue Medicare Advantage Choice (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Medicare Advantage Choice (PPO) with no coinsurance, though only some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Blue Medicare Advantage Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, prior hospital stays of less than three days are allowed, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Blue Medicare Advantage Choice (PPO) partially covers other services, offering a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. Members receive a maximum of $75 every three months for OTC items, while acupuncture and other miscellaneous services are not covered.
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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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