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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 2026, 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 2026 to people living in Select Dallas 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 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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $450.00 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 Classic (PPO) plan features an annual prescription drug deductible of $450. For generic prescriptions, you can save money by using preferred pharmacies or mail-order services, which offer no copay for Tier 1 preferred generics and copays as low as $1 for Tier 2 generics. Standard pharmacies and mail-order options are also available with slightly higher copays, ranging from $5 to $18 depending on the drug tier and supply length. For brand-name and specialty medications, your costs are determined by coinsurance percentages during the initial coverage phase. Tier 3 preferred brand drugs require a 17% coinsurance at preferred locations and 20% at standard locations, while Tier 4 non-preferred drugs require 40% or 43% coinsurance. Specialty medications in Tier 5 carry a flat 27% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Classic (PPO) plan provides robust medical coverage, featuring a $15 copay for primary care visits and a $55 copay for specialists with no coinsurance. Emergency care is covered with a $110 copay, while urgent care visits require a $40 copay. Inpatient hospital stays require daily copays for the first six days followed by no copay for subsequent days, while telehealth and home health services are available with no copay. Routine dental, vision, and hearing exams are covered with no copays, and the plan provides up to $100 annually for eyewear alongside partial coverage for prescription hearing aids. Skilled nursing facility care features no copay for days 1 to 20, while durable medical equipment and dialysis services require a 20% coinsurance with no copay. Covered preventive services, including annual physicals and fitness benefits, are also fully covered with no copays or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Blue Cross Medicare Advantage Classic (PPO) with no coinsurance, though prior authorization is required. Acute stays require a $405 daily copay for days 1-6 and no copay for subsequent days, while psychiatric stays require a $270 daily copay for days 1-6 and no copay for days 7-90; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Classic (PPO) covers outpatient hospital services with no coinsurance and a $0 to $400 copay, observation services with no coinsurance and a $395 copay per stay, and substance abuse sessions with no coinsurance and a $75 copay. Ambulatory surgical center services are covered with no copay and no coinsurance, while outpatient blood services require no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Blue Cross Medicare Advantage Classic (PPO) with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Classic (PPO) covers ground ambulance services with a $275 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Classic (PPO) covers emergency services with a $110 copay and no coinsurance, which is waived if admitted to the hospital within 3 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 Classic (PPO) covers primary care physician visits for a $15 copay and specialist visits for a $55 copay, both with no coinsurance. Other covered benefits, including mental health, psychiatric, and physical therapies, require copays ranging from $15 to $55 with no coinsurance, while telehealth services feature no copay and no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Classic (PPO) offers partially covered preventive services with no copays and no coinsurance for covered options such as annual physicals, fitness benefits, remote access, kidney disease education, glaucoma screenings, and diabetes training. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, bathroom safety devices, or counseling services.
Hearing Services See details
Hearing services are covered by Blue Cross Medicare Advantage Classic (PPO), featuring a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Classic (PPO) partially covers vision services with no copay, no coinsurance, and no deductible, offering up to $40 annually for routine eye exams and up to $100 annually for contact lenses, eyeglass lenses, and frames. Other eye exams, combined eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Classic (PPO) offers partially covered dental services, featuring a $50.00 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for select routine exams, cleanings, and x-rays. Non-covered services include fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Classic (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Blue Cross Medicare Advantage Classic (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Classic (PPO) with no copays, though prior authorization is required and a 20% coinsurance applies to durable medical equipment, prosthetics, and diabetic shoes. Diabetic supplies feature between no coinsurance and 20% coinsurance and are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Classic (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have no coinsurance and a copay ranging from $0 to $100, lab services and outpatient X-rays require a $5 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Classic (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Classic (PPO) covers cardiac rehabilitation services with no copay and no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Classic (PPO) with no coinsurance, featuring no copay for days 1 to 20 and 60 to 100, and a $218 daily copay for days 21 to 59. This benefit is partially covered because prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the Blue Cross Medicare Advantage Classic (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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