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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 Lowcountry. 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, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy, or 21% coinsurance for standard generic drugs at a preferred pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The BlueCross Total Value (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency services, primary care, preventive services, and home health services are covered, often with no or low copays. The plan also includes coverage for hearing, vision, and dental services, as well as medical equipment and diagnostic services. Additional benefits include coverage for ambulance services, skilled nursing facilities, and cardiac rehabilitation. The plan also provides coverage for home infusion services and dialysis services. However, it's important to note that certain services like acupuncture, private duty nursing, and some dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you pay a $465 copay for days 1-2 and no copay for days 3-90; for Inpatient Hospital Psychiatric, you pay a $675 copay for days 1-3 and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $325 copay per stay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40, and Outpatient Blood Services have 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.
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, and there is no coinsurance, but Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueCross Total Value (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $10 copay. Worldwide Emergency Coverage has a 20% coinsurance and a maximum plan benefit coverage of $25,000. Worldwide Urgent Coverage has a $45 copay, and 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, and occupational therapy services with a $35 copay. Physician specialist services have a copay between $17 and $47, while mental health and psychiatric services in individual or group sessions have a $50 and $45 copay, respectively. Physical therapy and speech-language pathology services have a $15 copay, and additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a 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, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $699 and $999 for all types of prescription hearing aids except those for the inner, outer, or over the ear which are not covered. OTC hearing aids are not covered.
Vision Services See details
The BlueCross Total Value (PPO) plan covers eye exams with a copay of $0-$50, and routine eye exams with no copay. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The BlueCross Total Value (PPO) plan covers Medicare dental services with a $50 copay, and covers other dental services, including oral exams, dental x-rays, and other diagnostic services. The plan does not cover fluoride treatment, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueCross Total Value (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueCross Total Value (PPO) plan. 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 no copay and coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment with a 0-20% coinsurance for Diabetic Supplies and a 20% coinsurance for Diabetic Therapeutic Shoes/Inserts. 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, but Lab Services are not covered. Diagnostic Procedures/Tests have a copay between $0 and $150, and Therapeutic Radiological Services have a 20% coinsurance, while 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 and no copay. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the BlueCross Total Value (PPO) plan, but the plan does not cover any of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, with no coinsurance.
Other Services See details
The BlueCross Total Value (PPO) plan does not cover 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, or Self-Directed Personal Assistance Services. The plan covers Over-the-Counter (OTC) Items with a maximum benefit of $60 every three months, and covers a meal benefit for chronic illness.
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