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Blue Cross Blue Shield Nebraska MA Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Blue Shield Nebraska MA Access (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Blue Shield Nebraska MA Access (PPO) in 2025, please refer to our full plan details page.
Blue Cross Blue Shield Nebraska MA Access (PPO) is a PPO plan offered by Blue Cross Blue Shield of Nebraska available for enrollment in 2025 to people living in Omaha/ Lincoln Metro Area and Central Nebraska. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Blue Cross Blue Shield Nebraska MA Access (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 Blue Cross Blue Shield Nebraska MA Access (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 Blue Cross Blue Shield Nebraska MA Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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 Blue Cross Blue Shield Nebraska MA Access (PPO)
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Drug Coverage
The Blue Cross Blue Shield Nebraska MA Access (PPO) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $14.00, and for standard generic drugs, the copay is $47.00. For preferred brand drugs, the copay is $100.00, and for non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Blue Cross Blue Shield Nebraska MA Access (PPO) plan offers a wide range of healthcare benefits. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with varying copays depending on the service. Additionally, it covers primary care, preventive services, hearing, vision, and dental, with specific copays and coverage limits for some services. Other benefits include coverage for home health services, skilled nursing facilities, and medical equipment, though some services may require prior authorization or have coinsurance costs. The plan also offers coverage for home infusion services, and dialysis services. Please note that the plan does not cover services such as cardiac rehabilitation, and has limitations on other services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For acute care, you will pay a $390 copay for days 1-4, and no copay for days 5-90. For psychiatric care, you will pay a $420 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $350 copay, and observation services, also with a $350 copay. Ambulatory Surgical Center (ASC) Services have a $295 copay, while outpatient substance abuse services have a copay of $35 for both individual and group sessions. Outpatient blood services are also covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial hospitalization is covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan, with a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan. Ground and Air Ambulance Services have a $350 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $55 copay, and all have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Blue Cross Blue Shield Nebraska MA Access (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a $35 copay. The plan also covers mental health specialty services with a $35 copay, other healthcare professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $35 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam, and other preventive services. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services are covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan, with no copay for hearing exams, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are also covered, with a copay ranging from $395 to $1595, while OTC hearing aids and some prescription hearing aid sub-services are not covered.
Vision Services See details
The Blue Cross Blue Shield Nebraska MA Access (PPO) plan covers vision services, including eye exams with a $35 copay. This plan also covers eyewear, with a combined maximum benefit of $300 every year for both in-network and out-of-network services, along with contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, as well as other dental services, up to a maximum of $2050 per year. Oral exams are covered for up to 2 visits per year, while Dental X-Rays and Fluoride Treatment are covered for up to 1 visit per year. Adjunctive General Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetic Devices and Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 0-20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan, with Diagnostic Procedures/Tests costing between $30 and $350, and Diagnostic Radiological Services costing at least $195. Therapeutic Radiological Services have a 20% coinsurance, while Outpatient X-Ray Services have a $20 copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan with no copay or coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan. The plan does not cover any of the sub-services related to Cardiac Rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Blue Shield Nebraska MA Access (PPO) plan, but require prior authorization. For days 1-20 and 51-100, there is no copay; for days 21-50, the copay is $196. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Blue Cross Blue Shield Nebraska MA Access (PPO) plan's "Other Services" benefit includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $70 every three months. 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, and Self-Directed Personal Assistance Services are not covered.
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