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Blue Cross Medicare Advantage Health Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Health Choice (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 Health Choice (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Health Choice (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in TX Flex Card 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 Health Choice (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 Health Choice (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 Health Choice (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 $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:
Sign up for Blue Cross Medicare Advantage Health Choice (PPO)
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Drug Coverage
The Blue Cross Medicare Advantage Health Choice (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a small copay starting at $5. Tier 2 generic drugs are also highly affordable, with copays as low as $1 at preferred locations. For brand-name and specialty medications, costs are based on coinsurance percentages. Tier 3 preferred brand drugs require an 18% coinsurance at preferred pharmacies and 20% at standard locations, while Tier 4 non-preferred drugs range from 39% to 42% coinsurance. Specialty drugs in Tier 5 carry a flat 25% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Health Choice (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and preventive services. For specialized care, members pay a $46 copay for specialists and a daily copay of $405 for the first six days of inpatient hospital stays, with no copay required for day seven and beyond. Outpatient hospital services feature copays ranging from no copay up to $400, while emergency room visits carry a $110 copay that is waived upon admission. This PPO plan also includes routine care benefits, providing preventive dental exams, cleanings, and routine vision and hearing exams with no copay. Prescription hearing aids are partially covered with copays between $699 and $999, and the plan offers up to $100 annually for eyewear. Skilled nursing facility stays feature no copay for the first 20 days, though some services like transportation, acupuncture, and over-the-counter items are not covered.
Inpatient Hospital See details
Blue Cross Medicare Advantage Health Choice (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $405 daily copay for days 1 to 6 and no copay for day 7 and beyond. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $290 daily copay for days 1 to 6 and no copay for days 7 to 90, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers outpatient hospital services with a $0 to $400 copay and no coinsurance, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse services carry a $75 copay with no coinsurance, while outpatient blood services feature no copay and a 20% coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Health Choice (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 Health Choice (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 are not covered by the plan as transport to plan-approved or any health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers emergency services with a $110 copay, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered with a $110 copay and no coinsurance, although worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Health Choice (PPO) covers primary care physician visits and telehealth services with no copay and no coinsurance, while specialist visits require a $46 copay with no coinsurance. Physical, occupational, speech, psychiatric, and mental health therapies are covered with copays ranging from $35 to $40 and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services are partially covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, fitness benefits, and remote access technologies. However, multiple sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, while routine exams and fitting evaluations are available with no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers vision services with no copay and no coinsurance, providing up to $40 annually for one routine eye exam and a $100 annual limit for eyewear like contact lenses, individual lenses, and frames. This benefit is partially covered, as other eye exam services, upgrades, and bundled eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Health Choice (PPO) provides partial dental coverage, featuring Medicare-covered dental services for a $35 copay and no coinsurance. Preventive services like oral exams, cleanings, and x-rays are covered with no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, prosthodontic, and oral surgery services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Health Choice (PPO) with no copay, although prior authorization is required. Associated Part B drugs, including chemotherapy, radiation, and other medications, have a 0% to 20% coinsurance, while insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Health Choice (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 Health Choice (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copay and prior authorization required. Most covered equipment and supplies require a 20% coinsurance, though diabetic supplies range from no coinsurance up to 20% coinsurance and are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Health Choice (PPO) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic services feature no coinsurance, no copay for lab tests, and a copay of up to $100 for procedures, while radiological services offer no copay for outpatient X-rays and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Blue Cross Medicare Advantage Health Choice (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 not covered in practice under the Blue Cross Medicare Advantage Health Choice (PPO), as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. While the plan features no coinsurance and requires prior authorization, these services require copayments ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Health Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day 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 standard 100-day limit are not covered.
Other Services See details
Other services are not covered under the Blue Cross Medicare Advantage Health Choice (PPO), meaning acupuncture, over-the-counter (OTC) items, and meal benefits are not covered and have no plan-associated copays or coinsurance.
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