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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 2026, 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 Mid PPO. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $90.00. 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 $450.00 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 $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:
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Drug Coverage
The Blue Cross Medicare Advantage Choice Plus (PPO) plan features a $450 drug deductible. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail order services, compared to a $5 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs are also highly affordable, with a $1 copay for a one-month supply at preferred locations and a $6 copay at standard locations. Brand-name and specialty medications require coinsurance, with Tier 3 preferred brand drugs charging 17% coinsurance at preferred pharmacies and 20% at standard pharmacies. Tier 4 non-preferred drugs have a coinsurance of 37% at preferred locations and 39% at standard locations, while Tier 5 specialty drugs require 27% coinsurance regardless of the pharmacy type. Utilizing preferred pharmacies and preferred mail order options is the best way to minimize your out-of-pocket drug costs under this PPO plan.
Additional Benefits
The Blue Cross Medicare Advantage Choice Plus (PPO) plan provides comprehensive medical coverage with many services featuring no coinsurance and predictable copays. Members pay no copay and no coinsurance for primary care visits, telehealth services, and home health care, while specialist visits require a $52 copay. Inpatient acute hospital stays require a $350 daily copay for the first eight days, after which there is no copay. Routine dental, vision, and hearing exams are covered with no copay and no coinsurance, though select eyewear and hearing aids have specific coverage limits and copays. Skilled nursing facility care offers no copay for days 1 to 20, while emergency room visits carry a $125 copay that is waived if admitted. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Inpatient acute stays require a $350 daily copay for days 1 to 8 and no copay for days 9 and beyond, while inpatient psychiatric stays require a $225 daily copay for days 1 to 7 and no copay for days 8 to 90. Non-Medicare-covered stays, upgrades, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) outpatient services are covered with no coinsurance, featuring a $0 to $360 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions carry a $75 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Choice Plus (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers ambulance services with a $250 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgent care with a $50 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $125 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $52 copay and no coinsurance. Physical, occupational, and speech therapy services have a $40 copay, mental health services have a $30 copay, and both have no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) preventive services are partially covered with no copay and no coinsurance for annual physicals, fitness benefits, remote access technologies, and select screenings. Non-covered services include 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 benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers hearing exams with no coinsurance, requiring a $40 copay for Medicare-covered exams and no copay for annual routine exams and fittings. Prescription hearing aids are partially covered with no coinsurance and a $699 to $999 copay for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) provides partially covered vision services with no deductibles, featuring no copay and no coinsurance for annual routine eye exams (up to $40) and select eyewear like contact lenses, eyeglass lenses, and frames up to a $100 annual limit. A $35 copay and no coinsurance apply to general eyewear, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered under the Blue Cross Medicare Advantage Choice Plus (PPO) plan, excluding other diagnostic services, fluoride treatment, other preventive services, implants, and orthodontics. Medicare-covered dental requires a $35 copay and no coinsurance, while covered preventive and restorative services have no copay and no coinsurance, and oral surgery or adjunctive services have no copay and 50% coinsurance up to a $750 annual maximum.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Choice Plus (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical Equipment benefits under the Blue Cross Medicare Advantage Choice Plus (PPO) are covered with no copay, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient diagnostic procedures have a $0 to $100 copay, lab services have a $5 copay, therapeutic radiology has a minimum $45 copay, and outpatient X-rays require no copay.
Home Health Services See details
Home health services are covered by the Blue Cross Medicare Advantage Choice Plus (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, which carry copays of $30, $30, $15, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Blue Cross Medicare Advantage Choice Plus (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 50 to 100, a $218 daily copay for days 21 to 49, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Choice Plus (PPO) indicates some services are covered under the other services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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