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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Blue Cross Medicare Advantage Classic (PPO) is a PPO plan offered by Health Care Service Corporation available for the 2026 plan year to people living in NM $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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7355.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7355.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for out-of-network covered services, the plan will pay 100% of out-of-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic medications are also highly affordable, costing just a $1 copay for a one-month supply at preferred locations. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 17% coinsurance at preferred pharmacies and 19% at standard pharmacies, while Tier 4 non-preferred drugs range from 37% to 39% coinsurance. Specialty drugs in Tier 5 carry a flat 25% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $49 copay, while inpatient hospital stays have a $350 daily copay for the first seven days and no copay for subsequent days. Emergency room visits carry a $100 copay, which is waived if admitted, and urgently needed services require a $40 copay. For ancillary care, members benefit from routine hearing and vision exams with no copay, although routine dental services and eyewear are not covered under this plan. Durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, the plan includes a $40 quarterly allowance for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Classic (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $350 daily copay for days 1-7 and no copay for day 8 and beyond, while psychiatric stays require a $265 daily copay for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Classic (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $350 (or $350 per stay for observation services), and outpatient substance abuse sessions have a $75 copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Classic (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Classic (PPO) covers ambulance services with prior authorization, requiring a $250 copay and no coinsurance for ground services, and a 20% coinsurance with no copay for air services. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services under the Blue Cross Medicare Advantage Classic (PPO) are covered with a $100 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 3 days. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent services are partially covered with a $100 copay and no coinsurance, excluding worldwide emergency transportation which is not covered.
Primary Care See details
Blue Cross Medicare Advantage Classic (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits cost a $49 copay with no coinsurance. Mental health sessions, occupational therapy, and physical therapy require copays ranging from $30 to $55 with 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 with no copay and no coinsurance for annual physicals, fitness benefits, remote access technologies, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and post-welcome-visit EKGs. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Classic (PPO) covers hearing exams with no deductible and no coinsurance, requiring a $40 copay for Medicare-covered exams and no copay for routine annual exams and fitting evaluations. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Classic (PPO), offering one routine eye exam per year with no copay, no coinsurance, and no deductible up to a $40 maximum. Other eye exam services are not covered, and eyewear—including contact lenses, eyeglasses, and frames—is also not covered.
Dental Services See details
Blue Cross Medicare Advantage Classic (PPO) provides partial dental coverage limited to Medicare-covered dental services, which require a $40.00 copay and no coinsurance. Routine and comprehensive dental services, including exams, cleanings, x-rays, and restorative procedures, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Blue Cross Medicare Advantage Classic (PPO) with no copay, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry no coinsurance to 20% coinsurance, while insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Classic (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Classic (PPO) with no copay and 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Covered diabetic supplies feature no copay and a coinsurance ranging from no coinsurance to 20%, and prior authorization is required for these benefits.
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. Outpatient lab and X-ray services feature no copay, while diagnostic procedures require a copay of $0 to $100 and therapeutic radiological services have a minimum copay of $45.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Classic (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Classic (PPO) covers Cardiac Rehabilitation Services with no copay, no coinsurance, and prior authorization required. However, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is 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 60 through 100, a $218 daily copay applies for days 21 through 59, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Blue Cross Medicare Advantage Classic (PPO), offering over-the-counter (OTC) items with no copay and no coinsurance up to a $40 allowance every three months. However, acupuncture, meal benefits, and naloxone coverage are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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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