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Blue Cross Medicare Advantage Protect (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Protect (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 Protect (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Protect (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in TX MA Buydown 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 Protect (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Cross Medicare Advantage Protect (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 Protect (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $11000.00 (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 $11000.00 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
Prescription drugs are not covered by Blue Cross Medicare Advantage Protect (PPO).
Additional Benefits
The Blue Cross Medicare Advantage Protect (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and routine preventive services. Specialist visits require a $55 copay, while emergency care has a $110 copay and urgent care costs $40. For inpatient hospital stays, members pay a daily copay of $370 for days 1 through 6, followed by no copay for subsequent days. Routine dental, vision, and hearing exams are covered with no copay, though prescription hearing aids require a copay between $699 and $999. Home health services also feature no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance. Note that certain services, such as acupuncture, over-the-counter items, and meal programs, are not covered under this plan.
Inpatient Hospital See details
Blue Cross Medicare Advantage Protect (PPO) partially covers 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, followed by no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Blue Cross Medicare Advantage Protect (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $375, and observation services with a $370 copay per stay. Ambulatory surgical center services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay with no coinsurance, and outpatient blood services have no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Cross Medicare Advantage Protect (PPO) with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Protect (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 plan-approved or any other health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Protect (PPO) covers emergency services with a $110 copay (waived if admitted within 3 days) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered with a $110 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Protect (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $55 copay with no coinsurance. Physical, occupational, and mental health therapies have copays ranging from $35 to $40 with no coinsurance, but podiatry is not covered, and only some chiropractic services are covered as routine and other chiropractic services are excluded.
Preventive Services See details
Blue Cross Medicare Advantage Protect (PPO) offers partial coverage for preventive services, featuring no copay and no coinsurance for covered benefits such as annual physicals, fitness benefits, remote access technologies, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. Uncovered services under this plan include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services under the Blue Cross Medicare Advantage Protect (PPO) are partially covered, featuring no coinsurance for all services. Medicare-covered exams require a $40 copay, routine exams and hearing aid fittings have no copay, and prescription hearing aids require a $699 to $999 copay, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Protect (PPO) provides partially covered vision services with no copay, no coinsurance, and no deductible for annual routine exams and select eyewear. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Protect (PPO) partially covers dental services, offering Medicare-covered dental care for a $35 copay and no coinsurance, and preventive services like cleanings and exams for no copay and no coinsurance. Comprehensive benefits like restorative care have no copay and no coinsurance, while oral surgery and adjunctive services require a 50% coinsurance and no copay up to a $1,000 annual limit. Fluoride treatments, implant services, orthodontics, other diagnostic dental services, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Protect (PPO) covers Home Infusion bundled Services with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin carries a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Blue Cross Medicare Advantage Protect (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Blue Cross Medicare Advantage Protect (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a required prior authorization. Most covered equipment and supplies are subject to a 20% coinsurance, while diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Protect (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services have no coinsurance, featuring no copay for lab services and a $0 to $100 copay for tests, while radiological services require a 20% coinsurance for therapeutic services, a $0 minimum copay for diagnostic radiology, and no copay for outpatient X-rays.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Protect (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Protect (PPO) covers cardiac rehabilitation services with no coinsurance, although prior authorization is required. While some services are covered, specific sub-services such as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Protect (PPO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. There is no coinsurance for these services, which feature no copay for days 1 through 20 and 50 through 100, and a $218 daily copay for days 21 through 49.
Other Services See details
Other Services are not covered under the Blue Cross Medicare Advantage Protect (PPO) plan, which provides no coverage or benefits for acupuncture, over-the-counter (OTC) items, or meal programs. Because these services are not covered by the plan, members will be responsible for the full cost of these services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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