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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 2025, 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 Southern Illinois. 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 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan offers coverage for a variety of services with varying costs. Inpatient hospital stays have a copay, but some days have no copay, while outpatient services, including emergency and urgent care, have copays. Primary care and preventive services have no copay. The plan also provides benefits for hearing, vision, and dental services, with copays for some services like hearing exams, contact lenses, and dental services. Additionally, the plan covers home infusion, dialysis, medical equipment, diagnostic services, home health, and skilled nursing facility services with varying copays or coinsurance. However, some services like cardiac rehabilitation and other services like acupuncture are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-7 and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $350 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
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Outpatient hospital and observation services have a $375 copay, ambulatory surgical center services have a $295 copay, and both individual and group sessions for outpatient substance abuse have a copay between $75.00 and $75.00. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Classic (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Ground ambulance services have a $225 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 under the Blue Cross Medicare Advantage Classic (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $40 copay; all three have no coinsurance. Worldwide Urgent Coverage has a $125 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Blue Cross Medicare Advantage Classic (PPO) plan, primary care physician services have no copay, while chiropractic services have a $20 copay. Occupational therapy services have a $40 copay, and physician specialist services have a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a copay of $30 to $45 for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following a Welcome Visit, all with no copay. Other preventive services such as Health Education, In-Home Safety Assessment, and more are not covered.
Hearing Services See details
Hearing services include hearing exams with a $40 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, while prescription hearing aids have a copay between $699 and $999, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with no copay, covered once per year. Eyewear benefits are also covered, with a $35 copay for contact lenses; however, other eyewear services are not covered.
Dental Services See details
Dental services are partially covered by the Blue Cross Medicare Advantage Classic (PPO) plan, with a $35 copay for Medicare Dental Services. Orthodontic, restorative, adjunctive general, endodontic, periodontic, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Classic (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Blue Cross Medicare Advantage Classic (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home. Diabetic Supplies have a coinsurance between 0-20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have a $5 copay. Diagnostic Radiological Services have a copay of at most $300, Therapeutic Radiological Services have a copay of $45, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Classic (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 not covered by the Blue Cross Medicare Advantage Classic (PPO) plan. Prior authorization is required for these services, but the plan does not cover the services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. There is no copay for days 1-20 and days 60-100, but there is a $214 copay for days 21-59.
Other Services See details
Other Services are not covered under the Blue Cross Medicare Advantage Classic (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, and several other services are not covered.
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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.
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