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Blue Cross Medicare Advantage Protect (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Protect (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 Protect (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Protect (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in IL MA Only Buydown 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 Protect (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Cross Medicare Advantage Protect (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 Protect (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Blue Cross Medicare Advantage Protect (PPO).
Additional Benefits
The Blue Cross Medicare Advantage Protect (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, routine preventive services, and home health care. Specialist doctor visits require a $60 copay, while emergency room services have a $125 copay that is waived upon hospital admission. For inpatient hospital stays, patients pay a $370 daily copay for days one through six and no copay for subsequent days, with no coinsurance required. Supplemental services include routine dental, vision, and hearing exams with no copay or coinsurance. Dental coverage offers up to a $1,000 annual limit for restorative and preventive care, while vision benefits provide up to $100 annually for eyewear. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Protect (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $370 daily copay for days 1 to 6 and no copay for additional days, while psychiatric stays require a $290 daily copay for days 1 to 6 and no copay for days 7 to 90; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Protect (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 have no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $75 copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Protect (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
Blue Cross Medicare Advantage Protect (PPO) covers ground ambulance services with a $225 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Protect (PPO) covers emergency services with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $125 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Protect (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $60 copay and no coinsurance. Standard therapy, psychiatric, and mental health services have a $40 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Blue Cross Medicare Advantage Protect (PPO) with no copay and no coinsurance for services such as annual physical exams, fitness benefits, remote access technologies, and kidney disease education. However, several supplemental options are not covered, including health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits.
Hearing Services See details
Hearing services covered by the Blue Cross Medicare Advantage Protect (PPO) include routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with a copay between $699 and $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Protect (PPO) offers partially covered vision services with no copay and no coinsurance for routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames, up to an annual limit of $40 for exams and $100 for eyewear. Other eye exam services, upgrades, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered by Blue Cross Medicare Advantage Protect (PPO), with Medicare-covered dental requiring a $35 copay and no coinsurance, and routine exams, cleanings, and x-rays requiring no copay or coinsurance. Comprehensive benefits are covered up to a $1,000 annual limit, featuring no copay or coinsurance for restorative and periodontic care, and no copay with 50% coinsurance for oral surgery and adjunctive services. Fluoride, implants, orthodontics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Protect (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Part B chemotherapy, radiation, and other drugs feature no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Protect (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Protect (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic services, with no copays. Patients are responsible for a 20% coinsurance on DME, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Protect (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient X-rays have no copay, lab services carry a $5 copay, diagnostic procedures range from a $0 to $100 copay, and therapeutic radiology services have a minimum $60 copay.
Home Health Services See details
Home health services are covered by Blue Cross Medicare Advantage Protect (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 Protect (PPO) with no coinsurance and prior authorization required, though only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Protect (PPO) with no coinsurance, requiring no copay for days 1-20 and 60-100, and a $218 daily copay for days 21-59. Prior authorization is required, prior hospital stays of three days are not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Blue Cross Medicare Advantage Protect (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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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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