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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 Midlands/Coastal. 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:
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Drug Coverage
The BlueCross Total Value (PPO) plan has a $200 deductible for prescription drugs. After the deductible is met, your cost will vary depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you'll pay a $10 copay for preferred generic drugs at a preferred pharmacy, while specialty tier drugs have no copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The BlueCross Total Value (PPO) plan offers a variety of benefits, including coverage for inpatient and outpatient hospital services with varying copays. It also covers ambulance services and emergency services, with copays ranging from $10 to $310. Additional benefits include primary care with no copay, preventive services with no copay, and coverage for hearing, vision, and dental services with copays and coinsurance. The plan also covers home health services with no copay, and skilled nursing facility services with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered by the BlueCross Total Value (PPO) plan. For Inpatient Hospital-Acute, you'll pay a $465 copay for days 1-2, and no copay for days 3-90; for Inpatient Hospital-Psychiatric, you'll pay a $675 copay for days 1-3, and no copay for days 4-90.
Outpatient Services See details
Outpatient Services for BlueCross Total Value (PPO) include coverage for all outpatient hospital services, with copays ranging from $0 to $295, and also cover observation services with a $325 copay per stay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services include individual and group sessions with a $40 copay. Outpatient Blood Services have a $50 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueCross Total Value (PPO) plan with a $80 copay; prior authorization is required.
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, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the BlueCross Total Value (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $10 copay. 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 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 copay between $17 and $47, and physical therapy and speech-language pathology services with a $15 copay. The plan also covers mental health specialty services with a $50 copay for individual and group sessions, psychiatric services with a $45 copay for individual and group sessions, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with 20% coinsurance. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including annual physical exams, are covered with no copay. Kidney Disease Education Services have a $50 copay, and Other Preventive Services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. Fitness Benefit is covered. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a $45 copay, while prescription hearing aids have a copay between $699 and $999, depending on the type of hearing aid. OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$50, routine eye exams with no copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with coverage for a set number of pairs every two years; upgrades are not covered.
Dental Services See details
The BlueCross Total Value (PPO) plan covers Medicare Dental Services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, and oral and maxillofacial surgery with 50% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered, and orthodontics has a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the BlueCross Total Value (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 Value (PPO) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 15% and 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The BlueCross Total Value (PPO) plan covers diagnostic and radiological services, with a minimum copay of $0 and a maximum copay of $150 for diagnostic procedures/tests. Therapeutic Radiological Services have a coinsurance of 20% and outpatient X-ray services have a $10 copay. Lab services are not covered.
Home Health Services See details
Home health services are covered by the BlueCross Total Value (PPO) plan with no coinsurance and no copay. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueCross Total Value (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCross Total Value (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100, and additional days beyond Medicare-covered for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $53 every three months, and a meal benefit for a chronic illness, but acupuncture, Dual Eligible SNPs, 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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