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 2025, 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 2025.
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 $25.00. 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 $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) plan has an Enhanced Alternative drug benefit type and a $0 deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. Note that this plan's premium may be reduced if you qualify for the low-income subsidy, and the plan covers specialty tier drugs with no copay at preferred pharmacies.
Additional Benefits
The BlueCross Total (PPO) plan offers comprehensive coverage, including inpatient and outpatient services. You'll find no copay for primary care visits and annual physical exams, and a range of copays for specialist visits and other services. Additionally, the plan includes coverage for dental, vision, and hearing services, as well as medical equipment, with varying copays and coinsurance amounts. This plan also provides benefits for emergency services, ambulance and transportation services, and home health services with no copay. Other notable benefits include coverage for prescription hearing aids, and a quarterly allowance for over-the-counter items. However, some services like Cardiac Rehabilitation, and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $450 copay for days 1-2, and no copay for days 3-90. For Inpatient Hospital Psychiatric, there is a $675 copay for days 1-3, and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The BlueCross Total (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $295, and observation services with a $325 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient blood services have a $50 copay, and outpatient substance abuse services have a $40 copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization, and has an $80 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the BlueCross Total (PPO) plan. Ground and Air Ambulance Services have a $295 copay, with no coinsurance, while Transportation Services to any health-related location are covered up to 24 one-way trips per year using rideshare services, bus/subway, van, or medical transport. Transportation Services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueCross Total (PPO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $10 copay; Worldwide Emergency Coverage has a 20% coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueCross Total (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay (routine care is not covered), and occupational therapy services with a $35 copay. Also covered are physician specialist services with a copay between $17 and $47, mental health specialty services with a $50 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $15 copay. Additional telehealth benefits have a copay between $0 and $40, and opioid treatment program services are covered with a 20% coinsurance.
Preventive Services See details
The BlueCross Total (PPO) plan covers preventive services, including an annual physical exam with no copay. Kidney Disease Education Services have a $50 copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following a Welcome Visit have no copay. However, some services such as Health Education, In-Home Safety Assessments, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams, which have a $45 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but only prescription hearing aids of all types are covered with a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The BlueCross Total (PPO) plan covers vision services, including routine eye exams with a copay of $0-$50. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, each with a limit of one per every two years. However, upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $50 copay, Oral Exams (2 visits per year) and Dental X-Rays (1 per year) with no copay, and Orthodontic Services with a $4,500 yearly maximum. Other covered services include Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, and Oral and Maxillofacial Surgery, all with 50% coinsurance. Fluoride Treatment, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueCross Total (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the BlueCross Total (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 15% and 20%, and Prosthetics/Medical Supplies and Medical Supplies have a 20% coinsurance; Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a minimum copay of $0.00 and a maximum copay of $125.00. Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $300.00, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $10.00 copay.
Home Health Services See details
Home Health Services are covered by the BlueCross Total (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 BlueCross Total (PPO) plan. Some services are covered, including 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCross Total (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The BlueCross Total (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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. Over-the-Counter (OTC) Items are covered with a maximum plan benefit of $55.00 every three months, and the plan also offers a meal benefit for a chronic illness.
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