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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 2026, 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 and District of Columbia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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:
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Drug Coverage
The CareFirst BlueCross BlueShield Advantage Complete (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for standard pharmacy or mail-order prescriptions. Tier 2 generic drugs cost a $5 copay for a one-month supply at standard pharmacies, while standard mail-order options offer a flat $5 copay for up to a three-month supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies, with mail-order options providing a flat $47 copay for up to three months. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 40% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The CareFirst BlueCross BlueShield Advantage Complete (PPO) plan offers comprehensive medical coverage with predictable copays and no coinsurance for most primary services. Members enjoy no copay for primary care doctor visits, while specialist visits require a $35 copay. Inpatient hospital stays feature a set daily copay for the first five days and no copay for subsequent days, while emergency care is covered with a $110 copay. This plan also provides valuable supplemental benefits, including routine dental cleanings, vision exams, and routine hearing evaluations with no copay. Prescription hearing aids, comprehensive dental care, and eyeglasses are covered with varying copays and no coinsurance. Additionally, members benefit from home health services with no copay, up to 32 free one-way transportation trips annually, and a quarterly allowance for over-the-counter health items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by CareFirst BlueCross BlueShield Advantage Complete (PPO) with no coinsurance, though additional days, upgrades, and non-Medicare-covered stays are not covered. Acute stays require a $385 copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $250 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers outpatient hospital services with a $0 to $275 copay and outpatient observation services with a $275 daily copay, both with no coinsurance and requiring prior authorization. Ambulatory surgical center services require a $185 copay with no coinsurance and prior authorization, while outpatient substance abuse sessions have a $5 copay with no coinsurance, and blood services are covered with no copay, no deductible, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by CareFirst BlueCross BlueShield Advantage Complete (PPO) with a $20.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers ambulance services with a $200 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering up to 32 one-way trips per year to any health-related location with no copay and no coinsurance, though trips to plan-approved health-related locations are not covered.
Emergency Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers emergency services with a $110 copay and no coinsurance, and urgently needed services with a copay ranging from no copay to $10 and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with no copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) offers primary care doctor visits and opioid treatment with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Other covered services like physical therapy, psychiatry, and podiatry require a $5 copay and no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by CareFirst BlueCross BlueShield Advantage Complete (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and other preventive screenings. Additional preventive services are partially covered, offering a memory fitness benefit with no copay or coinsurance, while sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies are not covered.
Hearing Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) hearing benefits include Medicare-covered exams for a $20 copay and no coinsurance, as well as one routine exam and fitting evaluation per year with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $400 to $1,875 for up to two devices yearly, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by CareFirst BlueCross BlueShield Advantage Complete (PPO) with no deductible, offering routine eye exams with a $0 to $60 copay and no coinsurance. Covered eyeglasses require a $0 to $10 copay and no coinsurance, and contact lenses have no copay and no coinsurance, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by CareFirst BlueCross BlueShield Advantage Complete (PPO), offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare dental with a $40 copay and no coinsurance. Comprehensive services have copays ranging from $15 to $700 and no coinsurance up to a $1,500 annual limit, but other diagnostic dental, other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the CareFirst BlueCross BlueShield Advantage Complete (PPO) plan with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members will pay no copay for diagnostic tests, lab services, and diagnostic radiology, while outpatient X-rays require a $20 copay and therapeutic radiological services require an $80 minimum copay.
Home Health Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered. These listed non-covered services carry a $5 copay.
Skilled Nursing Facility (SNF) See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $180 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
CareFirst BlueCross BlueShield Advantage Complete (PPO) partially covers other services, featuring acupuncture with a $10.00 copay and no coinsurance for up to 24 treatments per year. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to $55.00 every three months, while meal benefits are not covered.
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* 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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