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Blue Cross Medicare Advantage Dental Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dental Premier (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in IL Enhanced Dental 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 Dental Premier (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 Dental Premier (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 Dental Premier (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:
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Drug Coverage
The Blue Cross Medicare Advantage Dental Premier (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service, while standard options require a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, with a $1 copay at preferred pharmacies and a $6 copay at standard pharmacies for a one-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 17% coinsurance at preferred pharmacies and 21% at standard pharmacies, while Tier 4 non-preferred drugs range from 32% to 35% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copays or coinsurance for primary care visits, telehealth services, and annual physical exams. True to its name, the plan provides comprehensive dental care with no copay and no coinsurance up to a $3,000 annual maximum, alongside routine vision and hearing exams with no copays. Specialist visits are also highly affordable, requiring only a $25 copay and no coinsurance. For more serious medical needs, emergency room visits carry a $110 copay, while inpatient hospital stays require a $370 daily copay for the first six days and no copay for subsequent days. Additionally, members benefit from home health services and the first 20 days of skilled nursing facility care with no copays or coinsurance. Diagnostic outpatient X-rays and many preventive screenings are also fully covered with no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dental Premier (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a $370 daily copay for days 1 to 6 of acute stays and a $290 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $400 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 sessions require a $75 copay, with prior authorization required for most services.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Blue Cross Medicare Advantage Dental Premier (PPO), which requires prior authorization and charges a $225 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers emergency services with a $110 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are partially covered with a $110 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Therapy, mental health, and other specialty services have copays ranging from $15 to $50 with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered under the Blue Cross Medicare Advantage Dental Premier (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, remote access technologies, and select screenings. However, several sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, weight management programs, and nutritional/dietary benefits.
Hearing Services See details
Hearing services covered by the Blue Cross Medicare Advantage Dental Premier (PPO) include routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay. Prescription hearing aids are partially covered with no coinsurance and a copay of $699 to $999 for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) partially covers vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year (up to $40) and eyewear like contact lenses, eyeglass lenses, and frames (up to a combined $100 yearly limit), while other eye exams, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) offers partially covered dental services with a $3,000 annual maximum, featuring preventive and restorative care with no copay and no coinsurance, and Medicare-covered dental for a $35 copay and no coinsurance. Other covered comprehensive services have no copay and 0% to 20% coinsurance, though fluoride treatments, implants, orthodontics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and other drugs, feature no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copays and generally a 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Dental Premier (PPO) with no coinsurance, although prior authorization is required. Outpatient X-rays have no copay, lab services have a $5 copay, diagnostic procedures range from no copay up to $100, and therapeutic radiological services have a minimum copay of $60.
Home Health Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers home health services 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 Dental Premier (PPO) with no coinsurance and require prior authorization. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and carry copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Dental Premier (PPO) with no coinsurance and no required prior three-day hospital stay, though prior authorization is required. You will pay no copay for days 1 to 20 and days 60 to 100, a $218 daily copay for days 21 to 59, and additional days beyond the standard 100 days are not covered.
Other Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) does not cover any supplemental Other Services, meaning acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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