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 Midlands/Coastal. 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 $19.00. 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. This plan has a $0 deductible. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while specialty tier drugs have no copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The BlueCross Total (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, and outpatient services have copays ranging from $0 to $325. Many services have no copay, including primary care visits, preventive services, and routine eye exams. The plan also includes coverage for ambulance services, emergency services, hearing exams, vision services, dental services, and home infusion. Dental services have a 50% coinsurance, and a maximum of $4500 per year for orthodontic services. Additional benefits include coverage for medical equipment, diagnostic services, home health services, and skilled nursing facilities with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $450 copay for days 1-2 and no copay for days 3-90 for Inpatient Hospital-Acute, and a $675 copay for days 1-3 and no copay for days 4-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $295, and observation services have a $325 copay. Ambulatory surgical center services have no copay, and outpatient blood services have a $50 copay. Outpatient substance abuse services have a copay of $40 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueCross Total (PPO) plan. Ground and air ambulance services have a $295 copay, with no coinsurance. Transportation Services - Any Health-related Location is covered for up to 24 one-way trips per year, utilizing rideshare services, bus/subway, van, and medical transport. Transportation Services - Plan Approved Health-related Location is not covered.
Emergency Services See details
Emergency Services are covered by the BlueCross Total (PPO) plan, with a $110 copay, and no coinsurance. Urgently Needed Services have a $10 copay and no coinsurance, while Worldwide Emergency Coverage has a 20% coinsurance. Worldwide Urgent Coverage has a $45 copay, and 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, and occupational therapy services with a $35 copay. It also covers specialist visits 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 have a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services and an annual physical exam, are covered with no copay. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit also have no copay.
Hearing Services See details
Hearing services include coverage for hearing exams with a $45 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (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 eye exams with a copay between $0 and $50, and routine eye exams with no copay. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The BlueCross Total (PPO) plan covers dental services, including oral exams with a $50 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery, all with a 50% coinsurance. Orthodontic services have a maximum benefit of $4500 per year. However, fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueCross Total (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs, with coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and require 20% coinsurance.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics/medical supplies, and diabetic equipment. DME has a coinsurance between 15% and 20%, and requires authorization. Prosthetic devices and medical supplies have 20% coinsurance and require authorization, while diabetic supplies have a coinsurance between 0% and 20%, and diabetic therapeutic shoes/inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the BlueCross Total (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $125, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the BlueCross Total (PPO) plan with no coinsurance and no copay. 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. This includes 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) benefits are covered by the BlueCross Total (PPO) plan with prior authorization required. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
Other services include coverage for over-the-counter items and meal benefits. The plan offers a maximum of $51 every three months for over-the-counter items, including nicotine replacement therapy and naloxone, and meal benefits are provided for chronic illness. 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 are not covered.
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