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 Midlands/Coastal. 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 $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 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) Medicare plan features a $400 prescription drug deductible, with excellent cost savings on lower-tier medications. You will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs when using preferred pharmacies or standard mail order. For Tier 2 generic medications, copays start as low as $5 for a one-month supply at preferred pharmacies and standard mail order. Higher-tier medications under this plan transition to coinsurance, with Tier 3 preferred brand drugs requiring a flat 25% coinsurance across all pharmacy options. Tier 4 non-preferred drugs carry a 25% coinsurance at preferred pharmacies and standard mail order, rising to 30% at standard pharmacies, while Tier 5 specialty drugs require a 28% coinsurance for a one-month supply. Choosing preferred network pharmacies and standard mail-order options will help you maximize your savings on this plan.
Additional Benefits
The BlueCross Total (PPO) plan offers robust medical coverage featuring no copays and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $35 copay, while emergency room visits carry a $115 copay that is waived if you are admitted. For inpatient hospital stays, you will pay no coinsurance, with daily copays of $425 or $690 for the first three days and no copay for the remaining covered days. This plan also includes valuable supplemental benefits, such as routine vision exams and preventive dental care with no copays. Comprehensive dental services are covered with a 50% coinsurance up to a $2,500 annual limit, and hearing exams are available with a $45 copay. Additionally, members benefit from up to 24 free one-way transportation trips per year and a $50 quarterly over-the-counter item allowance with no copays.
Inpatient Hospital See details
BlueCross Total (PPO) covers inpatient hospital services with no coinsurance, requiring a $425 copay per day for days 1 to 3 of acute stays and a $690 copay per day for days 1 to 3 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and specific services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueCross Total (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center services with no copay and blood services with a $50 copay. Outpatient hospital services carry a $0 to $315 copay, observation services cost a $375 copay per stay, and outpatient substance abuse sessions require a $40 copay, with prior authorization needed for surgical, hospital, and observation services.
Partial Hospitalization See details
BlueCross Total (PPO) covers partial hospitalization services with no coinsurance, requiring either a $35.00 or $105.00 copay depending on the service. Prior authorization is required for services associated with the $105.00 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. Transportation services are also covered with no copay and no coinsurance, providing up to 24 one-way trips per year to any health-related location via rideshare, van, medical transport, or public transit.
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 copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a 20% coinsurance (no copay) for emergency care and a $45 copay (no coinsurance) for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
BlueCross Total (PPO) covers primary care visits with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Therapy and mental health services are also covered with no coinsurance and copays ranging from $20 to $50, though podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by BlueCross Total (PPO) with no copay and no coinsurance for annual physicals, glaucoma screenings, and diabetes self-management, while kidney disease education requires a $50 copay and no coinsurance. Although a memory fitness benefit is covered, several additional preventive services, including health education, in-home safety assessments, and medical nutrition therapy, are not covered.
Hearing Services See details
BlueCross Total (PPO) covers hearing exams with a $45 copay and no coinsurance, which includes one routine exam and unlimited fitting evaluations annually. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueCross Total (PPO) with no deductibles and no coinsurance, although upgrades and other eye exam services are not covered. Routine eye exams and covered eyewear are available with no copay, while other eye exams carry a copay ranging from $0 to $50.
Dental Services See details
BlueCross Total (PPO) offers partially covered dental services, featuring Medicare-covered dental with a $50 copay and no coinsurance, and preventive care with no copay and no coinsurance. Comprehensive dental services are covered with no copay and a 50% coinsurance up to a $2,500 annual maximum, though fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueCross Total (PPO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BlueCross Total (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
BlueCross Total (PPO) covers medical equipment with no copays, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. Coinsurance ranges from 15% to 20% for DME, is 20% for prosthetics and medical supplies, and ranges from no coinsurance to 20% for diabetic supplies and services.
Diagnostic and Radiological Services See details
BlueCross Total (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiological services with no copay and no coinsurance. Diagnostic procedures and tests have copays ranging from $0 to $125 with no coinsurance, while outpatient X-rays require a $10 copay plus coinsurance, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under BlueCross Total (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BlueCross Total (PPO) provides Cardiac Rehabilitation Services with no copay and no coinsurance, but prior authorization is required. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
BlueCross Total (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. The benefit is partially covered as prior authorization is required and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
BlueCross Total (PPO) partially covers other services, providing over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Covered OTC items include nicotine replacement therapy and naloxone with a maximum benefit of $50 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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