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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 OK MA Only 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $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
Prescription drugs are not covered by Blue Cross Medicare Advantage Protect (PPO).
Additional Benefits
The Blue Cross Medicare Advantage Protect (PPO) plan offers medical coverage with no copay and no coinsurance for primary care visits, routine annual physicals, and home health services. For inpatient hospital stays, members pay daily copays ranging from $290 to $380 with no coinsurance, while specialist visits require a $55 copay. Emergency care is available with a $100 copay, and urgent care has a $40 copay, both with no coinsurance. This plan also features no copays or coinsurance for preventive dental care, routine eye exams, and routine hearing tests, though annual limits and copays apply to comprehensive dental, eyewear, and hearing aids. For specialized medical needs, diagnostic lab services require a $5 copay, while durable medical equipment, dialysis, and Medicare Part B drugs feature no copay but require up to a 20% coinsurance. There is no plan deductible for vision services, and many services require prior authorization.
Inpatient Hospital See details
Blue Cross Medicare Advantage Protect (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $380 daily copay for days 1 to 7 (with no copay for additional days), while psychiatric stays require a $290 daily copay for days 1 to 6 and no copay for days 7 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Blue Cross Medicare Advantage Protect (PPO) with no coinsurance, featuring a $0 to $395 copay for hospital services and a $380 daily copay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $75 copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Protect (PPO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Protect (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Protect (PPO) partially covers emergency services, offering emergency care with a $100 copay (waived if admitted within three days) and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered with a $100 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Protect (PPO) covers primary care and telehealth visits with no copay and no coinsurance, while specialist and other healthcare professional visits require a $55 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays ranging from $35 to $50 and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Protect (PPO) covers preventive services, including annual physicals, kidney disease education, and fitness benefits, with no copay and no coinsurance. Additional preventive benefits are only partially covered; services such as 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 benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Protect (PPO) covers hearing services, featuring Medicare-covered exams with a $40 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two aids per year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Protect (PPO) covers routine eye exams, contact lenses, eyeglass lenses, and frames with no copay, no coinsurance, and no deductible, up to annual limits of $40 for exams and $100 for eyewear. Other eye exams, upgrades, and complete eyeglasses packages are not covered.
Dental Services See details
Blue Cross Medicare Advantage Protect (PPO) partially covers dental services, providing Medicare-covered dental for a $35 copay and no coinsurance, and preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive dental services are capped at a $750 annual maximum and range from no copay and no coinsurance to no copay and 50% coinsurance, but fluoride, implants, orthodontics, and other diagnostic or 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 and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Protect (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Protect (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic shoes, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and range from no coinsurance to 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Blue Cross Medicare Advantage Protect (PPO) with no coinsurance, though prior authorization is required. There is no copay for outpatient X-rays, a $5 copay for lab services, no copay to a $100 copay for diagnostic tests, and a minimum $60 copay for therapeutic radiological services.
Home Health Services See details
Blue Cross Medicare Advantage Protect (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically offered with no coinsurance under Blue Cross Medicare Advantage Protect (PPO), though prior authorization is required. While some services are covered, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Protect (PPO) covers skilled nursing facility (SNF) services with no coinsurance, although prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered. There is no copay for days 1 to 20 and days 60 to 100, while a $218 daily copay applies for days 21 to 59.
Other Services See details
Blue Cross Medicare Advantage Protect (PPO) does not cover Other Services, meaning there is no coverage or benefits provided for acupuncture, over-the-counter (OTC) items, or meals.
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