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Blue Cross Medicare Advantage Classic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Classic (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 Classic (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Classic (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in IL $0 Low 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 Classic (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 Classic (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 Classic (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.
This plan has a $615.00 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 Classic (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when utilizing a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, costing only a $1 copay for a one-month supply at preferred locations. Brand-name and specialty medications transition to coinsurance, with Tier 3 preferred brand drugs requiring 17% coinsurance at preferred pharmacies compared to 19% at standard pharmacies. Tier 4 non-preferred drugs carry a 36% to 39% coinsurance, while Tier 5 specialty drugs require 25% coinsurance for a one-month supply. Choosing preferred pharmacies and mail-order services helps maximize your savings on this plan.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low $17 copay, while inpatient hospital stays require daily copays and outpatient services feature varying copays with no coinsurance. Emergency care is accessible with a $125 copay, which is waived if you are admitted, and urgent care visits cost $40. This plan also includes valuable dental, vision, and hearing benefits to help lower your healthcare expenses. Routine vision and preventive dental services are available with no copay, and comprehensive dental is covered up to $1,000 annually with coinsurance ranging from 0% to 50%. Additionally, routine hearing exams have no copay, while diagnostic tests, dialysis, and durable medical equipment typically require a 20% coinsurance or low copays.
Inpatient Hospital See details
Blue Cross Medicare Advantage Classic (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring prior authorization and a daily copay of $380 for days 1 to 7 of acute stays and $290 for days 1 to 6 of psychiatric stays, with no copay for subsequent days. Non-Medicare-covered stays, upgrades, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Classic (PPO) covers outpatient services with no coinsurance, though copays vary depending on the service. There is no copay or coinsurance for ambulatory surgical center and outpatient blood services, while outpatient hospital visits have a $0 to $380 copay, observation services require a $325 copay per stay, and outpatient substance abuse sessions cost a $75 copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Classic (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Blue Cross Medicare Advantage Classic (PPO), with ground ambulance services requiring a $250 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, but transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Classic (PPO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within 3 days, and urgent care with a $40 copay and no coinsurance. Worldwide emergency and urgent services 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 Classic (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $17 copay and no coinsurance. Physical, occupational, psychiatric, and mental health therapies carry a $40 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Classic (PPO) preventive services are partially covered, featuring no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, remote access technologies, and kidney disease education. However, several supplemental services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems (PERS), and weight management programs.
Hearing Services See details
Hearing services are covered by Blue Cross Medicare Advantage Classic (PPO), featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with copays ranging from $699 to $999 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 covered by Blue Cross Medicare Advantage Classic (PPO) with no copay, no coinsurance, and no deductible, though other eye exam services, packaged eyeglasses (lenses and frames), and upgrades are not covered. Covered services include one routine eye exam per year up to a $40 maximum, as well as contact lenses, eyeglass lenses, and frames up to a combined $100 annual limit.
Dental Services See details
Dental services are partially covered under the Blue Cross Medicare Advantage Classic (PPO) plan, featuring Medicare-covered dental care for a $35 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive dental services are covered up to a $1,000 annual limit with no copay and coinsurance ranging from 0% to 50%, though other diagnostic services, fluoride, other preventive dental, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Classic (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
The Blue Cross Medicare Advantage Classic (PPO) plan covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Blue Cross Medicare Advantage Classic (PPO) with no copay, though prior authorization is required and most items carry a 20% coinsurance. This coverage includes durable medical equipment, prosthetics, and diabetic supplies, which have a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Classic (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic tests and procedures range from no copay up to $100, lab services require a $5 copay, outpatient X-rays have no copay, and therapeutic radiology services start at a $60 copay.
Home Health Services See details
Blue Cross Medicare Advantage Classic (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Blue Cross Medicare Advantage Classic (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Classic (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 50 through 100, a $218 daily copay for days 21 through 49, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Classic (PPO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Since these services are not covered, there are no copays or coinsurance associated with them.
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