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Blue Cross Medicare Advantage Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Choice Plus (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice Plus (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Chicago Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Blue Cross Medicare Advantage Choice Plus (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 Medicare Advantage Choice Plus (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 Medicare Advantage Choice Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $84.00. 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 $10100.00 (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 $10100.00 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 Medicare Advantage Choice Plus (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Choice Plus (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you can expect to pay a $10 copay for preferred generic drugs at a preferred pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium may be reduced, with the plan costing $22.10 per month.
Additional Benefits
The Blue Cross Medicare Advantage Choice Plus (PPO) plan offers a variety of benefits with varying costs. You can expect no copay for many services, including primary care, preventive services, routine eye exams, and home health services. However, you will have copays for inpatient hospital stays, outpatient services, specialist visits, hearing exams, and other services. This plan includes coverage for emergency services, ambulance services, hearing, vision, and dental. The plan also covers home infusion services, dialysis, and medical equipment, but may require prior authorization and involve coinsurance. Be aware that services like cardiac rehabilitation, and some other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a $350 copay for days 1-8, and no copay for days 9-90, and Inpatient Hospital Psychiatric, with a $225 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute is covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered by this plan. Outpatient hospital and observation services have a $300 copay, Ambulatory Surgical Center (ASC) Services have a $200 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $75 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency coverage, are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Emergency services have a $125 copay, urgently needed services have a $50 copay, and worldwide emergency coverage and worldwide urgent coverage have a $125 copay; there is no coinsurance for any of these services.
Primary Care See details
The Blue Cross Medicare Advantage Choice Plus (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while specialist services have a $48 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $40 copay. Additionally, telehealth benefits are covered with no copay, and opioid treatment program services have a $40 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including annual physical exams, are covered with no copay. Additional preventive services, including fitness and remote access technologies, are covered with a $0 copay. Other preventive services include glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay. Routine hearing exams are covered once per year with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types of prescription hearing aids, but the plan does not cover inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and one exam is covered per year. Eyewear has a $35 copay for contact lenses, and a combined maximum of $100 per year for both in-network and out-of-network services. Contact lenses and eyeglass lenses have no copay, while eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Choice Plus (PPO) plan covers oral exams and dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment and orthodontics are not covered, while restorative services have no coinsurance, and adjunctive general services have 50% coinsurance. The plan also covers periodontics and oral and maxillofacial surgery with 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have a 0-20% coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, Lab Services with a $5 copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with a $45 copay, and Outpatient X-Ray Services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Choice Plus (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 Blue Cross Medicare Advantage Choice Plus (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan, but prior authorization is required. You will have no copay for days 1-20 and days 50-100, and a $214 copay for days 21-49.
Other Services See details
Other Services are not covered by the Blue Cross Medicare Advantage Choice Plus (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, 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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