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 Lowcountry. 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) plan features an annual drug deductible of $400. You can save on prescriptions by using preferred pharmacies or standard mail order, which offer no copay for Tier 1 Preferred Generic and Tier 6 Select Care drugs. For Tier 2 Generic drugs, the cost is a low $5 copay for a one-month supply at preferred pharmacies and standard mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 Preferred Brand drugs require a 25% coinsurance, while Tier 4 Non-Preferred drugs carry a 25% coinsurance at preferred pharmacies and a 30% coinsurance at standard pharmacies. Tier 5 Specialty drugs require a 28% coinsurance for a one-month supply.
Additional Benefits
The BlueCross Total (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, preventive screenings, and home health services. Specialist visits require a $35 copay, while inpatient hospital stays and skilled nursing care involve daily copays for initial days with no coinsurance. Emergency room visits carry a $115 copay and urgent care is just $10, with both services waiving coinsurance. For extra benefits, the plan provides routine vision exams and standard eyewear with no copay, alongside preventive dental care with no copay and comprehensive dental covered at 50% coinsurance. Routine hearing exams require a $45 copay, while prescription hearing aids have copays ranging from $699 to $999. Durable medical equipment and Part B drugs are also covered with no copays and coinsurance ranging up to 20%.
Inpatient Hospital See details
BlueCross Total (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $425 daily copay for days 1 to 3 and no copay thereafter, while psychiatric stays require a $690 daily copay for days 1 to 3 and no copay for days 4 to 90; upgrades, non-Medicare 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 outpatient hospital services with copays ranging from $0 to $315. Patients will also pay a $375 copay per stay for observation services, a $40 copay for outpatient substance abuse sessions, and a $50 copay with no deductible for blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueCross Total (PPO) plan with no coinsurance and a copay of either $35.00 or $105.00 depending on the service. Prior authorization is required for services under 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. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to any health-related location, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
BlueCross Total (PPO) emergency services are covered with a $115 copay and urgently needed services with a $10 copay, both featuring no coinsurance and waived fees if admitted within 24 hours. Worldwide emergency and urgent care are partially covered up to a $25,000 limit with 20% coinsurance for emergency care and a $45 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
BlueCross Total (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $35 copay and no coinsurance. Physical therapy requires a $20 copay and no coinsurance, psychiatric and mental health services range from a $40 to $50 copay with no coinsurance, while chiropractic and podiatry 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 and screenings, while kidney disease education requires a $50 copay and no coinsurance. Additional preventive benefits are partially covered, offering memory fitness with no copay and no coinsurance, but excluding sub-services such as health education, in-home safety assessments, personal emergency response systems, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by BlueCross Total (PPO), excluding over-the-counter hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids. Covered routine exams and fitting evaluations require a $45 copay and no coinsurance, while covered prescription hearing aids carry a $699 to $999 copay and no coinsurance.
Vision Services See details
Vision Services are partially covered by BlueCross Total (PPO), offering eye exams with a $0 to $50 copay and eyewear with no copay, both featuring no coinsurance and no deductibles. While annual routine eye exams and standard eyewear are covered, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
BlueCross Total (PPO) partially covers dental services, offering Medicare-covered dental with a $50 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 50% coinsurance up to a $2,500 annual maximum, though fluoride treatments, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueCross Total (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
BlueCross Total (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required for these services.
Medical Equipment See details
BlueCross Total (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays across all categories. Coinsurance ranges from 15% to 20% for durable medical equipment, is 20% for prosthetics and medical supplies, and ranges from no coinsurance up to 20% for diabetic services and inserts.
Diagnostic and Radiological Services See details
BlueCross Total (PPO) covers diagnostic and radiological services with prior authorization required, offering lab services with no copay and no coinsurance, and diagnostic procedures with a $0 to $125 copay and no coinsurance. Outpatient X-rays require a $10 copay, while diagnostic radiological services have a minimum $0 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
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
BlueCross Total (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required and specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered. These non-covered services have copays ranging from $20 to $40.
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 additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BlueCross Total (PPO) partially covers other services, offering a meal benefit for chronic illnesses and a $50 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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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