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 2025, 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 2025.
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 $200.00 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 $14000.00 (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 $14000.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueCross Total Value (PPO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies and a $15 copay at standard pharmacies. Specialty tier drugs have no copay at preferred pharmacies and a $5 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The BlueCross Total Value (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. You'll have no copay for primary care visits and many preventive services. The plan also includes coverage for hearing and vision services, with copays for exams and hearing aids, as well as dental services with a 50% coinsurance for most dental work. Additional benefits include ambulance services, emergency services, and coverage for mental health services. The plan also covers home health services and skilled nursing facilities, but they require prior authorization. You'll also have access to other services, such as over-the-counter items and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a copay of $465 for days 1-2, and no copay for days 3-90; for Inpatient Hospital Psychiatric, you pay a copay of $675 for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered, and non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered; additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $295, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with a $50 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueCross Total Value (PPO) plan, with an $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueCross Total Value (PPO) plan. Ground and Air Ambulance Services have a $310 copay, but no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the BlueCross Total Value (PPO) plan, with a $110 copay. Urgently Needed Services have a $10 copay. Worldwide Emergency Coverage has a 20% coinsurance, and Worldwide Urgent Coverage has a $45 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueCross Total Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $17-$47 copay, mental health specialty services with a $50 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, and additional telehealth benefits with a $0-$45 copay. Opioid treatment program services are covered with 20% coinsurance.
Preventive Services See details
The BlueCross Total Value (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 are covered, including hearing exams and prescription hearing aids. Hearing exams have a $45 copay, and prescription hearing aids have a copay between $699 and $999 depending on the type.
Vision Services See details
Vision services include eye exams with a copay of $0-$50, and coverage for routine eye exams with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
The BlueCross Total Value (PPO) plan covers Medicare dental services with a $50 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, each with a 50% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered, and there is a $3,000 annual maximum benefit for orthodontic services.
Home Infusion bundled Services See details
The BlueCross Total Value (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%; prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the BlueCross Total Value (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits under the BlueCross Total Value (PPO) plan include Durable Medical Equipment (DME) with a 15-20% coinsurance and no copay, Prosthetic Devices with a 20% coinsurance and no copay, and Medical Supplies with a 20% coinsurance and no copay. Diabetic Equipment has a 0-20% coinsurance depending on the service, with Diabetic Supplies having a 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts having a 20% coinsurance, and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueCross Total Value (PPO) plan, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $150, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $300, Therapeutic Radiological Services have a minimum coinsurance of 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the BlueCross Total Value (PPO) plan with no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCross Total Value (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 items with a maximum benefit of $54 every three months, and a meal benefit for a chronic illness, but 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved