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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 2025, 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 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 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 $590.00 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 $13300.00 (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 $13300.00 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 has a $590 deductible for prescription drugs. After you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and where you fill your prescription. For preferred generic drugs, you'll pay a $10 copay at preferred pharmacies, and $20 at standard pharmacies. For preferred brand drugs and non-preferred drugs, you'll pay 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with copays ranging from $75 to $375. You'll find no copay for primary care, preventive services like annual physical exams, routine hearing and vision exams, and many dental services. The plan also provides coverage for emergency services, ambulance services, and home health services, as well as skilled nursing facility stays. Additional benefits include coverage for hearing aids, vision services including eyewear, and a wide array of diagnostic and therapeutic services. However, this plan does not cover several services, including cardiac rehabilitation, additional hours of care, and certain other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $370 copay for days 1-6, and no copay for days 7-90; additional days have no copay. For Inpatient Hospital Psychiatric, you pay a $290 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 are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a copay of $375 and $370, respectively, while ambulatory surgical center services have a copay of $300. Outpatient substance abuse services have a copay of $75 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan. Ground ambulance services have a $225 copay, while air ambulance services have a 20% coinsurance; however, 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 Dental Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $45 copay, and there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Dental Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $32 copay, mental health specialty services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $50 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and Additional Preventive Services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. This plan does not cover Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post-discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams are covered with no copay. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered with a copay between $699 and $999 per year, while OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all of which have no copay, and a combined maximum plan benefit coverage of $100 per year for both in-network and out-of-network services; however, 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, as well as oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment and orthodontics are not covered, and the plan has a $5,000 annual maximum for orthodontic services. Restorative services, and adjunctive general services have no coinsurance. Endodontics, prosthodontics (removable), maxillofacial prosthetics, and prosthodontics (fixed) have a 20% coinsurance. Periodontics and Oral and Maxillofacial Surgery have a coinsurance that ranges from 0% to 20%. Implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay, and other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and 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, Lab Services with a $5 copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with a $60 copay, and Outpatient X-Ray Services with no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) plan, with a copay of $0 for days 1-20, $214 for days 21-59, and $0 for days 60-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, and several other services are not covered.
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