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Blue Cross Medicare Advantage Complete (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Complete (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 Complete (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Complete (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in TX broad-market 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 Complete (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 Complete (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 Complete (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 $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:
Sign up for Blue Cross Medicare Advantage Complete (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Complete (PPO) plan features an annual drug deductible of $450. For generic medications, you can benefit from no copay on Tier 1 preferred generics when using a preferred pharmacy or preferred mail-order service. Tier 2 generics are also highly affordable, costing as little as a $1 copay for a one-month supply through preferred networks. For brand-name and specialty drugs, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require an 18% coinsurance at preferred pharmacies and 20% at standard pharmacies, while Tier 4 non-preferred drugs carry up to 44% coinsurance. Specialty medications in Tier 5 require a 27% coinsurance across all pharmacy options for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Complete (PPO) offers comprehensive coverage for essential medical services with predictable costs, featuring no coinsurance for many primary care and hospital services. Members enjoy no copay for telehealth visits, routine preventive care, and home health services, while primary care doctor visits require a low $10 copay and specialist visits cost $51. Inpatient hospital stays and skilled nursing facility care are also covered with daily copays for initial days and no copay for subsequent days. For additional care, this PPO plan covers routine dental, vision, and hearing exams with no copay, alongside a vision allowance and affordable copays for hearing aids. Emergency care requires a $125 copay, which is waived if you are admitted, while urgently needed services have a $50 copay. Diagnostic tests, durable medical equipment, and dialysis services are also covered, typically requiring a 20% coinsurance or low copays.
Inpatient Hospital See details
Blue Cross Medicare Advantage Complete (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $425 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $270 daily copay for days 1 to 6 and no copay for days 7 to 90. Some services are not covered, including upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Blue Cross Medicare Advantage Complete (PPO) covers outpatient hospital services with copays ranging from $0 to $425 and no coinsurance, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse services require a $75 copay with no coinsurance, while outpatient blood services have no copay and a 20% coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Complete (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Complete (PPO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Complete (PPO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency services are partially covered with a $125 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Complete (PPO) covers primary care visits with a $10 copay and specialist visits with a $51 copay, both with no coinsurance. Additional covered services include mental health sessions for a $30 copay, physical, occupational, and speech therapy for a $40 copay, and telehealth with no copay, all featuring no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Complete (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, fitness benefits, remote access technologies, kidney disease education, and glaucoma screenings. However, several additional services are not covered under this plan, such as health education, weight management programs, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Blue Cross Medicare Advantage Complete (PPO) covers hearing exams with no deductible or coinsurance, requiring a $50.00 copay for Medicare-covered exams and no copay for routine annual exams. Prescription hearing aids are partially covered with a $699.00 to $999.00 copay 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 Complete (PPO) provides partially covered vision services with no copay and no coinsurance for covered care. Covered benefits include one routine eye exam and a $100 annual allowance for contact lenses, eyeglass lenses, and eyeglass frames, while other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Complete (PPO) provides partially covered dental services, featuring Medicare-covered dental care with a $50 copay and no coinsurance, alongside routine exams, cleanings, and x-rays with no copay and no coinsurance. Sub-services that are not covered under this plan include fluoride, orthodontics, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Complete (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Blue Cross Medicare Advantage Complete (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Complete (PPO) covers durable medical equipment, prosthetics, and diabetic equipment with no copays and a 20% coinsurance, though diabetic supplies can have no coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Complete (PPO) covers diagnostic services with prior authorization, offering no coinsurance, a $5 copay for lab services, and diagnostic test copays ranging from no copay to $100. Radiological services also require prior authorization and include outpatient X-rays for a $5 copay, therapeutic radiological services with a minimum 20% coinsurance, and diagnostic radiological services starting with no copay.
Home Health Services See details
Blue Cross Medicare Advantage Complete (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Complete (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Complete (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 60 through 100, a $218 daily copay for days 21 through 59, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Complete (PPO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Because these services are not covered, members are responsible for the full cost and there are no copay or coinsurance benefits.
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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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