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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 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 Midlands/Coastal. 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 generic medications, the plan offers excellent savings, including no copay for Tier 1 preferred generics and Tier 6 select care drugs when filled at preferred pharmacies or through standard mail order. Tier 2 generics are also highly affordable, costing as little as a $5 copay for a one-month supply at preferred pharmacies. For brand-name and specialty medications, costs are determined by coinsurance percentages rather than flat copays. Tier 3 preferred brands require a 20% coinsurance at preferred pharmacies or standard mail order, while Tier 4 non-preferred drugs carry a 28% coinsurance. Specialty Tier 5 drugs have a flat 25% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The BlueCross Total Value (PPO) plan offers comprehensive medical coverage featuring no copays or coinsurance for primary care visits, home health services, and annual preventive care. Specialist visits require a $45 copay, while emergency room services carry a $115 copay. Inpatient hospital stays require a daily copay for the first few days, after which there is no copay, and skilled nursing facility care is covered with no copay for the first 20 days. For routine care, the plan provides vision exams and eyewear with no copay, as well as preventive dental services at no cost. Comprehensive dental care is covered with no copay and a 50% coinsurance up to $1,500, while hearing exams require a $45 copay. Members also benefit from a $25 quarterly over-the-counter allowance and up to 24 free one-way transportation trips annually to health-related locations.
Inpatient Hospital See details
BlueCross Total Value (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care stays require a $425 copay per day for days 1 through 4 (with no copay thereafter and unlimited additional days), while psychiatric stays require a $690 copay per day for days 1 through 3 (with no copay for days 4 through 90), but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueCross Total Value (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $315 and observation services with a $375 copay per stay. Ambulatory surgical center services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a $40 copay and outpatient blood services have a $50 copay, both with no coinsurance.
Partial Hospitalization See details
BlueCross Total Value (PPO) covers partial hospitalization services with no coinsurance and a copay of either $45.00 or $105.00. Prior authorization is required for the services with the $105.00 copay.
Ambulance and Transportation Services See details
BlueCross Total Value (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Transportation services to any health-related location are also covered with no copay or coinsurance for up to 24 one-way trips per year, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
BlueCross Total Value (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $25,000 maximum, featuring a 20% coinsurance and no copay for emergency care, a $45 copay and no coinsurance for urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
BlueCross Total Value (PPO) features primary care physician visits with no copay and no coinsurance, and specialist visits for a $45 copay with no coinsurance. Therapy services are covered with copays ranging from $25 to $35 and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
BlueCross Total Value (PPO) preventive services are partially covered, offering annual physicals, memory fitness, glaucoma screenings, diabetes training, rectal exams, and EKGs with no copay and no coinsurance, alongside kidney disease education for a $50 copay and no coinsurance. Sub-services that are not covered under this plan include 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, smoking cessation counseling, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
BlueCross Total Value (PPO) covers hearing exams with a $45 copay, no coinsurance, and no deductible, which includes one routine exam annually and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $699 to $999 for up to two devices per year, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
BlueCross Total Value (PPO) partially covers vision services, offering eye exams with a $0 to $50 copay and no coinsurance, and eyewear with no copay and no coinsurance. Routine eye exams, contacts, and eyeglasses are covered, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
BlueCross Total Value (PPO) provides partially covered dental services, featuring preventive care with no copay or coinsurance and Medicare-covered dental for a $50 copay and no coinsurance. Comprehensive services are covered with no copay and 50% coinsurance up to a $1,500 annual limit, though fluoride treatments, implant services, 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. Under this benefit, Medicare Part B chemotherapy and other drugs require 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the BlueCross Total Value (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
BlueCross Total Value (PPO) covers medical equipment with no copays, though prior authorization and coinsurance will apply. Durable medical equipment requires a 15% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under BlueCross Total Value (PPO) with prior authorization required. Diagnostic tests and procedures have no coinsurance and a $0 to $150 copay, lab services have no copay or coinsurance, and diagnostic radiological services have copays starting at $0 with no coinsurance. Outpatient X-rays require a $10 copay plus coinsurance, while therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the BlueCross Total Value (PPO) plan 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, and require prior authorization. However, only some services are covered, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BlueCross Total Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by BlueCross Total Value (PPO), offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive a $25 OTC allowance every three months, while the meal benefit has no maximum coverage limit.
Get Personalized Help from a licensed insurance agent
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