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Blue Cross Medicare Advantage Health Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Health Choice (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 Health Choice (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Health Choice (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in IL Flexcard 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 Health Choice (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 Health Choice (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 Health Choice (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 $13900.00 (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 $13900.00 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 Health Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Health Choice (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay at preferred retail pharmacies and through preferred mail order services, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay for a one-month supply at preferred pharmacies compared to a $6 copay at standard pharmacies. For higher-tier medications, cost-sharing transitions to coinsurance, with Tier 3 preferred brand drugs requiring 17% coinsurance at preferred pharmacies and 20% at standard pharmacies. Tier 4 non-preferred drugs carry a 36% coinsurance at preferred pharmacies and 38% at standard locations, while Tier 5 specialty drugs require a flat 25% coinsurance across all pharmacy options. Utilizing preferred pharmacies and mail-order services helps plan members maximize their savings on prescription drug costs.
Additional Benefits
The Blue Cross Medicare Advantage Health Choice (PPO) plan offers robust medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. Specialist visits require a $45 copay, while inpatient hospital stays incur daily copays for the first several days before transitioning to no copay. Emergency room visits have a $110 copay, and outpatient hospital services feature copays ranging up to $400 with no coinsurance. For ancillary care, the plan provides preventive dental and routine vision services with no copay, while comprehensive dental services require up to 20% coinsurance. Routine hearing exams are also covered with no copay, though prescription hearing aids require copays ranging from $699 to $999. Additionally, medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Health Choice (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $365 daily copay for acute care days 1 through 7 (with no copay for subsequent days) and a $290 daily copay for psychiatric care days 1 through 6 (with no copay for days 7 through 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers outpatient services with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services and a $370 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay with no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Health Choice (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers ambulance services with prior authorization, requiring a $225 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within 3 days, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $110 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Health Choice (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Other covered services like therapy and mental health care have copays ranging from $15 to $50 with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are only partially covered; fitness benefits and remote access technologies are included at no cost, while health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers hearing services, offering Medicare-covered exams for a $40 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. Hearing aids are partially covered, with a copay of $699 to $999 and no coinsurance for up to two prescription hearing aids per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Health Choice (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered benefits. This includes one routine eye exam (up to $40) and eyewear (up to $100) annually for contact lenses, eyeglass lenses, and frames, while other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Health Choice (PPO) offers partially covered dental services, featuring Medicare-covered dental for a $35 copay and no coinsurance, alongside preventive care with no copay or coinsurance. Other comprehensive services have no copay and 0% to 20% coinsurance up to a $750 annual limit, but fluoride, implants, orthodontics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay and no coinsurance, subject to prior authorization. Covered Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin services also requiring a $35 copay.
Dialysis Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Health Choice (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copays and a 20% coinsurance for most items. Diabetic supplies feature a coinsurance ranging from no coinsurance to 20%, and prior authorization is required for these covered benefits.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient X-rays have no copay, lab services require a $5 copay, diagnostic procedures range from a $0 to $100 copay, and therapeutic radiological services have a minimum copay of $60.
Home Health Services See details
Home health services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 60 to 100, and a $218 daily copay for days 21 to 59. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the 100-day Medicare benefit period are not covered.
Other Services See details
Other services are partially covered by Blue Cross Medicare Advantage Health Choice (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $40 limit every three months, while acupuncture and meal benefits are not covered.
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