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 Lowcountry. 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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies, and specialty tier drugs have no copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueCross Total (PPO) plan offers a range of benefits with varying costs. Hospital stays have copays ranging from $0 to $675 depending on the type and length of stay, while outpatient services have copays between $0 and $325. You'll also find coverage for services like ambulance, emergency care, primary care, preventive services, hearing, vision, dental, and more, each with specific copays or coinsurance amounts. Additional benefits include home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. The plan also covers durable medical equipment, and offers over-the-counter items, and meal benefits. However, certain services like cardiac rehabilitation and some specialized care options are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $450 copay for days 1-2, and no copay for days 3-90, while Inpatient Hospital Psychiatric has a $675 copay for days 1-3, and no copay for days 4-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $295, and observation services with a $325 copay. Ambulatory Surgical Center services have no copay, while Outpatient Substance Abuse services have a $40 copay for both individual and group sessions. Outpatient blood services have a $50 copay, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueCross Total (PPO) plan, but requires prior authorization. You will pay an $80 copay for this service.
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. Transportation services to any health-related location are covered for up to 24 one-way trips per year, using rideshare services, bus/subway, van, and medical transport; however, transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
The BlueCross Total (PPO) plan covers emergency services with a $110 copay, and urgently needed services with a $10 copay, both with no coinsurance. Worldwide Emergency Coverage has a 20% coinsurance, and Worldwide Urgent Coverage has a $45 copay; Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueCross Total (PPO) plan covers primary care physician services and mental health specialty services with a $0-$50 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $17-$47 copay, and physical therapy/speech-language pathology services with a $15 copay. The plan also offers additional telehealth benefits with a $0-$40 copay, and covers opioid treatment program services with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
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 include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with 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 are covered, but the sub-services Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear 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), and eyeglass lenses and frames, and you are eligible for a pair of each every two years. However, upgrades are not covered.
Dental Services See details
The BlueCross Total (PPO) plan covers Medicare dental services with a $50 copay, and other dental services including oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services (2 per year), prophylaxis (cleaning) (2 per year), and other preventive dental services (2 per year), with no copay and no coinsurance. This plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery with a 50% coinsurance, and orthodontic services with a $4,500 maximum benefit per year. Fluoride treatment and orthodontics are not covered, and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay. 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 prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a coinsurance between 15% and 20%, and requires authorization. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for diagnostic procedures/tests with a copay between $0 and $125, and outpatient X-Ray services with a $10 copay. Lab services are not covered. Diagnostic Radiological Services have a copay up to $300, while Therapeutic Radiological Services have a 20% coinsurance.
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 under the BlueCross Total (PPO) plan. Prior authorization is required for 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. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and meal benefits, with OTC items offering up to $55 every three months and including nicotine replacement therapy and naloxone coverage. 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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