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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 2025, 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 2025.
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 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 $5400.00 (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 $5400.00 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:
Sign up for Blue Medicare Advantage Choice (PPO)
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Drug Coverage
The Blue Medicare Advantage Choice (PPO) plan has an enhanced alternative drug benefit. This plan has no deductible. During the initial coverage phase, you'll 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 preferred mail order generic drugs have no copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Blue Medicare Advantage Choice (PPO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays require a copay, and outpatient services have varying copays depending on the type of service. Emergency, primary care, and preventive services are covered, with some services having no copay. The plan also includes coverage for hearing, vision, and dental services, with copays and limits on specific services like eyewear and dental care. Additional benefits include home health services with no copay, and coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities with associated copays or coinsurance. The plan also offers coverage for over-the-counter items with a quarterly limit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you pay a $330 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute have no copay, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, you pay a $330 copay for days 1-6, and no copay for days 7-90, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and ambulatory surgical center services, are covered under the Blue Medicare Advantage Choice (PPO) plan. Outpatient hospital services and ambulatory surgical center services have a $250 copay, while observation services have a $265 copay. Outpatient substance abuse services have a copay of $30 for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Medicare Advantage Choice (PPO) plan. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Medicare Advantage Choice (PPO) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Medicare Advantage Choice (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $20 copay, and Worldwide Emergency Coverage has a $140 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $40 copay for Occupational Therapy Services. Physician Specialist Services have a $30 copay, while Mental Health Specialty Services and Psychiatric Services have a $30 and $40 copay respectively for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay, 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, with specific services like health education, in-home safety assessments, and others not covered. Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $295 and $1495, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Blue Medicare Advantage Choice (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with a $30 copay for contact lenses. Eyeglass frames, lenses, and contacts are limited to one per year, and a combined maximum of $300 applies to all eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay. Other dental services, such as oral exams, dental x-rays, and cleanings, are covered with a yearly maximum benefit of $2250. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services include coverage for 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 Choice (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $250 with a minimum copay of $30, and Therapeutic Radiological Services have a coinsurance up to 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Advantage Choice (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 covered by the Blue Medicare Advantage Choice (PPO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Advantage Choice (PPO) plan, but require prior authorization. You will pay a copay of $20 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management, institution for mental disease services, services in an intermediate care facility, 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 are not covered. Over-the-counter items and meal benefits are covered. Over-the-counter items have a maximum benefit coverage of $50 every three months.
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