A non-government entity
BlueCross Total Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCross Total Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueCross Total Value (PPO) in 2026, please refer to our full plan details page.
BlueCross Total Value (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 2026.
It's important to know that BlueCross Total Value (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 Value (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 Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $615.00 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 $13900.00 (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 $13900.00 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 Value (PPO)
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Drug Coverage
The BlueCross Total Value (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, there is no copay when filled at a preferred pharmacy or through standard mail order. Tier 2 generic medications are also highly affordable, starting with a low $5 copay for a one-month supply at preferred pharmacies and standard mail order. For higher-tier prescriptions, costs are determined by coinsurance, with Tier 3 preferred brand drugs requiring a 20% coinsurance at preferred pharmacies and standard mail order. Tier 4 non-preferred drugs carry a 28% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Standard retail pharmacies generally charge slightly higher copays and coinsurance rates across all available drug tiers.
Additional Benefits
The BlueCross Total Value (PPO) plan provides comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits require a $45 copay, while emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours. For hospital stays, the plan features no coinsurance, though acute inpatient stays require a $425 daily copay for the first four days, after which there is no copay. Ancillary benefits include no copay, no deductible, and no coinsurance for routine vision exams, corrective eyewear, and preventive dental care, alongside comprehensive dental covered at 50% coinsurance up to a $1,500 annual limit. Routine hearing exams carry a $45 copay, while prescription hearing aids require copays ranging from $699 to $999. Additionally, members can access up to 24 one-way health-related transportation trips per year and receive a quarterly over-the-counter allowance of up to $25 with no copay and no coinsurance.
Inpatient Hospital See details
BlueCross Total Value (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $425 daily copay for days 1 to 4 with no copay for additional days, while psychiatric stays carry a $690 daily copay for days 1 to 3 and no copay for days 4 to 90.
Outpatient Services See details
BlueCross Total Value (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from $0 to $315 for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center services are covered with no copay and no coinsurance, while outpatient substance abuse sessions carry a $40 copay and blood services require a $50 copay with no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by BlueCross Total Value (PPO) with no coinsurance, requiring a copay of either $45.00 or $105.00 depending on the service. Prior authorization is required for the service with the $105.00 copay.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueCross Total Value (PPO), which features a $350 copay and no coinsurance for prior-authorized ground and air ambulance rides. The plan also covers up to 24 one-way trips per year to any health-related location with no copay and no coinsurance, though transportation to plan-approved health-related locations specifically is not covered.
Emergency Services See details
BlueCross Total Value (PPO) covers emergency services with a $115 copay and urgently needed services with a $10 copay, both featuring no coinsurance and copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum, requiring a 20% coinsurance with no copay for emergency care and a $45 copay with no coinsurance for urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under the BlueCross Total Value (PPO) feature primary care doctor visits with no copay and no coinsurance, and specialist visits for a $45 copay and no coinsurance. Most other covered services, such as physical therapy ($25 copay) and mental health sessions ($50 copay), require no coinsurance, though podiatry is not covered, chiropractic care is only partially covered, and opioid treatment requires a 20% coinsurance with no copay.
Preventive Services See details
Preventive Services are partially covered by BlueCross Total Value (PPO), featuring an annual physical, fitness benefits, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome-visit EKGs with no copay and no coinsurance, alongside kidney disease education for a $50 copay and no coinsurance. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home/bathroom safety, and counseling.
Hearing Services See details
Hearing Services are covered by BlueCross Total Value (PPO), which offers routine hearing exams and fitting evaluations for a $45 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two aids per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueCross Total Value (PPO) with no deductibles, no coinsurance, and no copays for covered services, though other eye exam services and eyewear upgrades are not covered. Covered benefits include one routine eye exam and one pair of contact lenses or eyeglass lenses per year, plus one set of eyeglass frames every two years.
Dental Services See details
BlueCross Total Value (PPO) covers Medicare dental services with a $50 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive dental services are partially covered with no copay and 50% coinsurance up to a $1,500 annual limit, though fluoride treatments, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueCross Total Value (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BlueCross Total Value (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by BlueCross Total Value (PPO) with no copays, though coinsurance ranges from 0% to 20% depending on the item. Durable medical equipment requires 15% to 20% coinsurance, prosthetics and medical supplies require 20% coinsurance, and diabetic supplies carry between no coinsurance and 20% coinsurance.
Diagnostic and Radiological Services See details
BlueCross Total Value (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab work, and a $0 to $150 copay for procedures. Radiological services require a $10 copay and coinsurance for x-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance plus copays for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by BlueCross Total Value (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under BlueCross Total Value (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
BlueCross Total Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required for these services, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BlueCross Total Value (PPO) partially covers other services, offering a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. OTC items are capped at a $25 maximum benefit every three months, while acupuncture is not covered.
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