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BlueCross Blue Basic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCross Blue Basic (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueCross Blue Basic (PPO) in 2025, please refer to our full plan details page.
BlueCross Blue Basic (PPO) is a PPO plan offered by BlueCross BlueShield of South Carolina (BCBSSC) available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that BlueCross Blue Basic (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueCross Blue Basic (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 Blue Basic (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $9550.00 (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 $9550.00 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 Blue Basic (PPO)
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Drug Coverage
Prescription drugs are not covered by BlueCross Blue Basic (PPO).
Additional Benefits
The BlueCross Blue Basic (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the specific service. This plan includes no copay for primary care physician visits and many preventive services, but there are copays for specialist visits, mental health services, and therapies. You will have a $325 copay for days 1-6 of inpatient hospital stays. Additional benefits include coverage for ambulance and transportation services, emergency services, and services for hearing, vision, and dental. The plan also covers home health services with no copay, and skilled nursing facility services with a copay after 20 days. There are also additional benefits like over-the-counter items with a maximum benefit, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-6 and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you pay a $645 copay for days 1-3 and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
The BlueCross Blue Basic (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $250, observation services with a $250 copay, and ambulatory surgical center services with no copay. The plan also covers 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 Blue Basic (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered, with a $275 copay for both ground and air ambulance services. Transportation services to any health-related location are covered for up to 24 one-way trips per year, using rideshare services, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services are covered under the BlueCross Blue Basic (PPO) plan, with a $110 copay, and Urgently Needed Services have a $10 copay. Worldwide Emergency Coverage has a 20% coinsurance, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have no copay, Chiropractic Services have a $15 copay, and Occupational Therapy Services have a $30 copay, and Physician Specialist Services have a $30 copay. Mental Health Specialty Services and Psychiatric Services have a $45 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have a copay between $0 and $40. Opioid Treatment Program Services have 20% coinsurance.
Preventive Services See details
The BlueCross Blue Basic (PPO) plan covers preventive services including an annual physical exam 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. Some additional preventive services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids with a $45 copay, and prescription hearing aids (all types) with a copay between $699 and $999; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. You can get one routine hearing exam and two prescription hearing aids per year.
Vision Services See details
Vision Services include eye exams with a copay of $0-$50, routine eye exams with no copay, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The BlueCross Blue Basic (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), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, prosthodontics (fixed), and oral and maxillofacial surgery, all with a 50% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered. Orthodontic Services have a maximum benefit of $3500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 Blue Basic (PPO) plan, with prior authorization required. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 15-20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with varying coinsurance. Durable Medical Equipment for use outside the home is not covered, while Diabetic Supplies have a 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueCross Blue Basic (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $150, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the BlueCross Blue Basic (PPO) plan with no copay and no coinsurance. 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 Blue Basic (PPO) plan. Prior authorization is required for this benefit, but none of the services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCross Blue Basic (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
The BlueCross Blue Basic (PPO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months, and also covers a Meal Benefit for chronic illnesses. However, acupuncture, 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, 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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