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 Lowcountry. 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) Medicare prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 6 select care drugs when filled at a preferred pharmacy or through standard mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a one-month supply at preferred pharmacies or through standard mail order. For higher-tier medications, cost-sharing transitions to coinsurance, with Tier 3 preferred brands requiring a 20% coinsurance at preferred pharmacies and standard mail order. Tier 4 non-preferred drugs carry a 28% coinsurance at preferred locations, while Tier 5 specialty drugs require 25% coinsurance across all pharmacy types for a one-month supply. Choosing standard pharmacies will generally increase your out-of-pocket costs, with coinsurance rates reaching up to 30% for non-preferred drugs.
Additional Benefits
The BlueCross Total Value (PPO) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care visits and routine preventive services. For specialized medical needs, members pay a $45 copay for specialist visits, while inpatient hospital stays require a daily copay for the first few days and no copay for subsequent days. Outpatient and diagnostic services generally feature no coinsurance, with copays ranging from no copay up to $315 depending on the procedure. This plan also includes valuable supplemental benefits, such as routine dental exams and annual vision screenings with no copay, alongside allowances for eyewear and hearing aids. Members can benefit from routine transportation for up to 24 one-way trips annually with no copay or coinsurance and a quarterly over-the-counter allowance. Other essential services like home health care also require no copay or coinsurance, making this plan a highly supportive option for everyday health management.
Inpatient Hospital See details
Inpatient hospital services are covered by BlueCross Total Value (PPO) with no coinsurance, requiring prior authorization. Acute care incurs a $425 daily copay for days 1 through 4 and no copay for subsequent days, while psychiatric stays require a $690 daily copay for days 1 through 3 and no copay for days 4 through 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueCross Total Value (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $315 for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center services are covered with no copay, while outpatient substance abuse sessions require a $40 copay and blood services have a $50 copay.
Partial Hospitalization See details
BlueCross Total Value (PPO) covers partial hospitalization services with no coinsurance, though copays and prior authorization requirements vary. Depending on the service, you will pay a copay of either $45.00 or $105.00, with the higher copay requiring prior authorization.
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 are partially covered with no copay or coinsurance for up to 24 one-way trips per year to any health-related location, 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 both copays waived if admitted within 24 hours. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum, featuring a 20% coinsurance (no copay) for emergency care and a $45 copay (no coinsurance) for urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
BlueCross Total Value (PPO) offers primary care physician services with no copay and no coinsurance, specialist visits for a $45 copay and no coinsurance, and opioid treatment with no copay and 20% coinsurance. Podiatry is not covered, some chiropractic services are covered but routine and other chiropractic care are not covered, and other therapies, telehealth, and mental health services require copays up to $50 with no coinsurance.
Preventive Services See details
BlueCross Total Value (PPO) provides preventive services with no copay and no coinsurance for annual physicals, memory fitness, glaucoma screenings, diabetes training, digital rectal exams, and EKGs, while kidney disease education requires a $50 copay and no coinsurance. Many additional preventive benefits 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
BlueCross Total Value (PPO) covers hearing services, offering annual routine hearing exams for a $45 copay and no coinsurance, as well as unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
BlueCross Total Value (PPO) partially covers vision services with no deductibles or coinsurance, offering one annual routine eye exam with no copay and other eye exams with a $0 to $50 copay. Eyewear is covered with no copay or coinsurance, including one pair of contact lenses or eyeglass lenses every year and frames every two years, though other eye exam services and upgrades are not covered.
Dental Services See details
BlueCross Total Value (PPO) provides partially covered dental services, featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care such as cleanings and exams. Comprehensive services like restorative and endodontic care are 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 and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
BlueCross Total Value (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
BlueCross Total Value (PPO) covers medical equipment with no copays, though coinsurance and prior authorizations may apply. Durable medical equipment carries a 15% to 20% coinsurance, prosthetic devices and medical supplies require a 20% coinsurance, and diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
BlueCross Total Value (PPO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic lab services have no copay or coinsurance, diagnostic procedures carry a $0 to $150 copay with no coinsurance, and radiological services require copays starting at $0 (including a $10 copay for X-rays) along with coinsurance up to 20% for therapeutic services.
Home Health Services See details
Home health services are covered by BlueCross Total Value (PPO) with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under the BlueCross Total Value (PPO) plan, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueCross Total Value (PPO) covers skilled nursing facility (SNF) services with no coinsurance and requires no prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the BlueCross Total Value (PPO) are partially covered, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $25 every three months via debit card, reimbursement, or claims processing, with no balance carryover.
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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.
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