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Blue Cross Medicare Advantage Choice Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Choice Premier (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 Premier (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Choice Premier (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Chicago Metro Area High 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 Premier (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 Premier (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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $155.00. 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 $300.00 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:
Sign up for Blue Cross Medicare Advantage Choice Premier (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Choice Premier (PPO) plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, starting at a $1 copay for a one-month supply at preferred locations. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require 18% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry up to a 46% coinsurance at standard pharmacies. Tier 5 specialty drugs require 29% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Blue Cross Medicare Advantage Choice Premier (PPO) plan offers comprehensive coverage for essential medical needs, featuring no copays or coinsurance for primary care visits, telehealth services, and routine preventive care. For specialist visits, members pay a $45 copay, while emergency care requires a $125 copay and urgent care has a $50 copay. Inpatient hospital stays require a daily copay of $350 for the first seven days of acute care, with no copay for subsequent days. This plan also includes key supplemental benefits, such as routine dental, vision, and hearing exams with no copays or coinsurance. Coverage for prescription hearing aids requires a $699 to $999 copay, while comprehensive dental services are covered up to $750 annually with no copays and up to 20% coinsurance. Additionally, skilled nursing facility stays feature no copay for days 1 to 20, while durable medical equipment and dialysis services generally require a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Choice Premier (PPO) provides partially covered inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays and a $225 daily copay for days 1 to 7 of psychiatric stays, with no copay for subsequent covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Blue Cross Medicare Advantage Choice Premier (PPO) are covered with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services have no copay or coinsurance, while outpatient substance abuse sessions require a $75 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Blue Cross Medicare Advantage Choice Premier (PPO) with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers ground ambulance services with a $225 copay and air ambulance services with a 20% coinsurance, both of which require prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers emergency services with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within 3 days, and urgent care with a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits require a $45 copay and no coinsurance, therapy services have a $40 copay and no coinsurance, and psychiatric and mental health services have a $30 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copays and no coinsurance. Some additional preventive benefits are only partially covered, excluding services such as health education, weight management, nutritional/dietary benefits, and in-home safety assessments.
Hearing Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers hearing exams with a $35 copay for Medicare-covered visits and no copay for routine annual exams or fitting evaluations, with no coinsurance required for these services. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Choice Premier (PPO), offering routine eye exams with no copay and no coinsurance up to a $40 annual limit, while other eye exam services are not covered. Eyewear is covered with a $35 copay and no coinsurance up to a $100 annual limit, although upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) provides partially covered dental services, featuring a $35 copay and no coinsurance for Medicare dental, and no copays or coinsurance for routine exams, cleanings, and x-rays. Comprehensive services are covered up to a $750 annual limit with no copays and 0% to 20% coinsurance, but other diagnostic services, fluoride, other preventive services, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Choice Premier (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and required prior authorization. A 20% coinsurance applies to most items, though diabetic supplies range from no coinsurance to 20% coinsurance and are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no coinsurance, though prior authorization is required. Outpatient X-rays require no copay, lab services carry a $5 copay, diagnostic procedures and tests range from no copay up to $100, and therapeutic radiological services have a minimum copay of $45.
Home Health Services See details
Home health services are covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Choice Premier (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, but only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Blue Cross Medicare Advantage Choice Premier (PPO) with no coinsurance, featuring no copay for days 1 to 20 and 40 to 100, and a $218 daily copay for days 21 to 39. Prior authorization is required, a 3-day prior hospital stay is not required, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Other services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered under the Blue Cross Medicare Advantage Choice Premier (PPO) plan. Because these services are not covered, members are responsible for the full cost of these items and services.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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