A non-government entity
BlueCross Total (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCross Total (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueCross Total (PPO) in 2026, please refer to our full plan details page.
BlueCross Total (PPO) is a PPO plan offered by BlueCross BlueShield of South Carolina (BCBSSC) available for enrollment in 2025 to people living in Upstate. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BlueCross Total (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 BlueCross Total (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 BlueCross Total (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $400.00 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 $13500.00 (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 $13500.00 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 BlueCross Total (PPO)
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Drug Coverage
The BlueCross Total (PPO) prescription drug plan features an annual drug deductible of $400. You can enjoy no copay for Tier 1 preferred generic and Tier 6 select care drugs when using a preferred pharmacy or standard mail order. Tier 2 generic drugs are also highly affordable, with copays starting at just $5 for a one-month supply. Higher tier medications are covered via coinsurance, with Tier 3 preferred brand drugs requiring a 25% coinsurance at all pharmacies. Tier 4 non-preferred drugs have a 25% coinsurance at preferred pharmacies and standard mail order, which rises to 30% at standard pharmacies. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply regardless of the pharmacy you choose.
Additional Benefits
BlueCross Total (PPO) provides comprehensive healthcare coverage with predictable costs, featuring no deductibles and numerous services with no copays or coinsurance. For instance, members enjoy no copay and no coinsurance for primary care visits, routine preventive care, and home health services. When hospital care is needed, outpatient services range from no copay to a $315 copay, while inpatient acute stays require a $425 daily copay for the first three days and no copay thereafter. Specialty care and supplemental benefits are highly accessible, with specialist visits requiring a $20 to $35 copay and routine eye exams and eyewear available with no copay. Preventive dental care features no copay, while comprehensive dental services require 50% coinsurance, and durable medical equipment is covered with 15% to 20% coinsurance and no copays. The plan also includes convenient extras at no cost, such as up to 24 one-way transportation trips and a $50 quarterly over-the-counter item allowance.
Inpatient Hospital See details
BlueCross Total (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Medicare-covered acute stays require a $425 daily copay for days 1 through 3 with no copay thereafter, while psychiatric stays require a $690 daily copay for days 1 through 3 and no copay for days 4 through 90.
Outpatient Services See details
BlueCross Total (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center services and a copay of $0 to $315 for outpatient hospital services. Observation services require a $375 copay per stay, outpatient substance abuse sessions have a $40 copay, and outpatient blood services carry a $50 copay with no deductible.
Partial Hospitalization See details
BlueCross Total (PPO) covers partial hospitalization with no coinsurance and a copay of either $35 or $105 depending on the service. Prior authorization is required for the services subject to the $105 copay.
Ambulance and Transportation Services See details
BlueCross Total (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, requiring prior authorization. Additionally, the plan covers up to 24 one-way transportation trips per year to any health-related location with no copay and no coinsurance, though plan-approved-only transportation services are not covered.
Emergency Services See details
BlueCross Total (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $25,000 limit, requiring a 20% coinsurance and no copay for emergency care and a $45 copay and no coinsurance for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
BlueCross Total (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require copays of $20 to $35 and no coinsurance. Mental health, psychiatric, and telehealth services feature copays ranging from $0 to $50 with no coinsurance, while opioid treatment requires a 20% coinsurance and no copay. Chiropractic and podiatry services are not covered.
Preventive Services See details
BlueCross Total (PPO) covers preventive services, including annual physical exams, glaucoma screenings, and diabetes training, with no copay and no coinsurance, though kidney disease education requires a $50 copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness program with no copay and no coinsurance, but excluding services such as health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
BlueCross Total (PPO) hearing services include routine exams and fitting evaluations for a $45.00 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699.00 to $999.00 and no coinsurance for up to two devices per year, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BlueCross Total (PPO) covers vision services with no deductible, no coinsurance, and copays ranging from $0 to $50, including one annual routine eye exam and eyewear with no copay. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under BlueCross Total (PPO), with Medicare-covered dental services requiring a $50 copay and no coinsurance. Preventive services are offered with no copay and no coinsurance, and comprehensive services require no copay and 50% coinsurance up to a $2,500 annual maximum, though fluoride treatments, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueCross Total (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
BlueCross Total (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
BlueCross Total (PPO) covers medical equipment with no copays, although coinsurance applies to most items and prior authorization is required for select benefits. Durable medical equipment carries a 15% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under BlueCross Total (PPO) with prior authorization required. Diagnostic procedures and lab services feature a $0 to $125 copay and no coinsurance, while radiological services require a $10 copay for X-rays, no copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by BlueCross Total (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueCross Total (PPO) with no copay, no coinsurance, and prior authorization required. However, in practice some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BlueCross Total (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by BlueCross Total (PPO), which offers a meal benefit for chronic illness and over-the-counter (OTC) items with no copay and no coinsurance, up to a $50 limit every three months. Acupuncture and other additional services are not covered under this plan.
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