A non-government entity
CareFirst BlueCross BlueShield Advantage Complete (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareFirst BlueCross BlueShield Advantage Complete (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareFirst BlueCross BlueShield Advantage Complete (PPO) in 2025, please refer to our full plan details page.
CareFirst BlueCross BlueShield Advantage Complete (PPO) is a PPO plan offered by CareFirst, Inc. available for enrollment in 2025 to people living in Maryland. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that CareFirst BlueCross BlueShield Advantage Complete (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 CareFirst BlueCross BlueShield Advantage Complete (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 CareFirst BlueCross BlueShield Advantage Complete (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.00. 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 $12300.00 (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 $12300.00 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 CareFirst BlueCross BlueShield Advantage Complete (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The CareFirst BlueCross BlueShield Advantage Complete (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, you may pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy (LIS), you will pay $6.80. Be sure to check the plan's formulary for specific drugs covered.
Additional Benefits
The CareFirst BlueCross BlueShield Advantage Complete (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with copays, and outpatient services with copays that vary by service. You'll find no copay for primary care and many preventive services, but copays apply for specialist visits, therapy, and other services. This plan also includes coverage for hearing, vision, and dental services, with copays for exams and varying coverage for hearing aids, eyewear, and dental procedures. Additional benefits include ambulance and transportation, emergency services, home health services, and access to over-the-counter items, with specific copays or coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $250 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include all outpatient hospital services, with copays ranging from $0 to $275, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) services have a $185 copay, and outpatient substance abuse services have a $5 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the CareFirst BlueCross BlueShield Advantage Complete (PPO) plan, with a $20 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by CareFirst BlueCross BlueShield Advantage Complete (PPO). Ground and Air Ambulance Services have a $200 copay, and Transportation Services to any health-related location are covered for up to 10 one-way trips per year. Transportation Services to Plan Approved Health-related Locations are not covered.
Emergency Services See details
Emergency Services are covered, with a $100 copay and no coinsurance. Urgently Needed Services are also covered, with a copay between $0 and $20, and no coinsurance. Worldwide Emergency Services are covered, with a maximum benefit of $50,000; Worldwide Emergency and Urgent Coverages are covered, but Worldwide Emergency Transportation is not covered.
Primary Care See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers primary care physician services with no copay, and chiropractic services with a $5 copay. The plan also covers occupational therapy services with a $5 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $5 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services are also covered, with varying copays depending on the specific service.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services such as In-Home Safety Assessments, Fitness Benefits (Memory Fitness), and Remote Access Technologies. Other services such as Health Education, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers hearing exams with a $20 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a copay between $400 and $1875, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a $20 copay, and routine eye exams have a copay of $0-$60. Eyewear has no copay; contact lenses have a maximum benefit coverage of $250 every year, and eyeglasses (lenses and frames) have a maximum benefit coverage of $200 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $40 copay, and other dental services with no copay for oral exams, x-rays, cleaning, and fluoride treatments. This plan also covers restorative services with a copay between $15 and $400, adjunctive general services with a copay between $15 and $30, endodontics with a copay between $100 and $200, periodontics with a copay between $50 and $300, removable prosthodontics with a copay between $30 and $700, implant services with a copay between $70 and $500, fixed prosthodontics with a copay between $40 and $400, and oral and maxillofacial surgery with a copay between $40 and $100. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the CareFirst BlueCross BlueShield Advantage Complete (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay. 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, lab services with no copay, diagnostic radiological services with a copay up to $175, therapeutic radiological services with a copay of $80 or more, and outpatient X-ray services with a $20 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the CareFirst BlueCross BlueShield Advantage Complete (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 CareFirst BlueCross BlueShield Advantage Complete (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CareFirst BlueCross BlueShield Advantage Complete (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $180 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The CareFirst BlueCross BlueShield Advantage Complete (PPO) plan covers acupuncture with a $10 copay, up to 24 treatments per year, and requires prior authorization. The plan also covers over-the-counter items, up to $55 every three months. Other services such as meal benefits, and home and community based services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved