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Blue Cross Medicare Advantage Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Elite (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 Elite (PPO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Elite (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 Elite (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 Elite (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 Elite (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 $250.00 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 Elite (PPO) plan has a $250 deductible for prescription drugs. After meeting your deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, a preferred generic drug has a $10 copay at a preferred pharmacy. For preferred brand drugs, you pay 42% coinsurance at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Elite (PPO) plan offers a range of benefits with varying costs. You'll have no copay for primary care, preventive services, routine vision and hearing exams, and home health services. Hospital stays have a copay, starting at $295, and other services like outpatient, emergency, and specialist visits have copays ranging from $40 to $375. The plan also provides coverage for dental, hearing aids, and medical equipment, with some services requiring coinsurance. Additionally, this plan includes coverage for ambulance services, with a $250 copay for ground transport and 20% coinsurance for air ambulance. There are also benefits for over-the-counter items up to $30 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $295 copay for days 1-9, and no copay for days 10-90, with additional days covered at no copay; non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $290 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services with the Blue Cross Medicare Advantage Elite (PPO) plan includes coverage for Outpatient Hospital Services with a $375 copay, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with a $300 copay, and Outpatient Substance Abuse Services with a $75 copay for both individual and group sessions, as well as Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Elite (PPO) plan, but requires prior authorization. You will pay a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Elite (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, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Elite (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $40 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Elite (PPO) plan offers primary care with no copay, chiropractic services with a $20 copay, and occupational therapy with a $40 copay. Physician specialist services have a $40 copay, physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits are covered with no copay. Mental health and psychiatric services, and opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Elite (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and kidney disease education services, are covered, with no copay.
Hearing Services See details
The Blue Cross Medicare Advantage Elite (PPO) plan covers hearing exams with a $40 copay, and routine hearing exams with no copay for one visit per year. Fitting/Evaluation for Hearing Aids are covered with no copay. Prescription hearing aids are covered, with a copay between $699 and $999 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Blue Cross Medicare Advantage Elite (PPO) plan covers vision services, including routine eye exams and eyewear. Eye exams and eyewear have no copay. The plan provides coverage for one routine eye exam per year with no copay, contact lenses with no copay, and one pair of eyeglass lenses and one pair of eyeglass frames per year with no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, and other dental services with no maximum plan benefit coverage. Oral exams, dental x-rays, and prophylaxis (cleaning) are covered with no copay, while fluoride treatment and orthodontics are not covered; restorative services and adjunctive general services have no coinsurance, while endodontics, prosthodontics removable, maxillofacial prosthetics, and prosthodontics fixed have 20% coinsurance, and periodontics and oral and maxillofacial surgery have 0-20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while the other drug services have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Elite (PPO) plan, but require prior authorization. You will pay a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Blue Cross Medicare Advantage Elite (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit, Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance, and Diabetic Equipment is covered. Diabetic Supplies have a coinsurance between 0% and 20%, 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, and lab services with a $5 copay. Diagnostic radiological services have a copay of at most $300, therapeutic radiological services have a copay of at least $60, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Elite (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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Elite (PPO) plan, but prior authorization is required. For days 1-20 and 50-100, there is no copay, while days 21-49 have a copay of $214.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, up to a maximum of $30 every three months. Acupuncture, Meal Benefit, 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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