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Blue Cross Medicare Advantage Dental Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dental Premier (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 Dental Premier (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dental Premier (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in OK Enhanced Dental 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 Dental Premier (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 Dental Premier (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 Dental Premier (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $11300.00 (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 $11300.00 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 Dental Premier (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies require a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, starting at a $1 copay for a one-month supply at preferred pharmacies. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs require a 17% coinsurance at preferred locations and 19% at standard locations, while Tier 4 non-preferred drugs range from 34% to 37% coinsurance. Specialty drugs in Tier 5 carry a flat 25% coinsurance for a one-month supply regardless of the pharmacy network type.
Additional Benefits
The Blue Cross Medicare Advantage Dental Premier (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $385 daily copay for the first six days and no copay thereafter, while specialist visits require a $39 copay. Emergency room visits have a $100 copay, and outpatient services range from no copay up to a $395 copay, both featuring no coinsurance. This plan highlights strong supplemental coverage, including routine vision and preventive dental care with no copay, alongside comprehensive dental services covered up to a $4,000 annual limit. Routine hearing exams also feature no copay, though prescription hearing aids require a copay between $699 and $999. For durable medical equipment, dialysis, and Medicare Part B drugs, members can expect no copay but a standard 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dental Premier (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, you pay a $385 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays cost a $290 daily copay for days 1 through 6 and no copay for days 7 through 90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $395 copay and observation services with a $370 copay per stay. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers ground ambulance services with a $250.00 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, both requiring prior authorization. Some transportation services are covered, but transport to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers emergency services with a $100 copay (waived if admitted to the hospital within three days) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered with a $100 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Dental Premier (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $39 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays ranging from $35 to $40 and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic care, while podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive benefits are partially covered, offering fitness benefits and remote access technologies with no copay or coinsurance, though services like health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) offers hearing services with no coinsurance, featuring a $40 copay for Medicare-covered exams and no copay for routine annual exams and fitting evaluations. Prescription hearing aids are partially covered with a copay between $699 and $999 and no coinsurance, though OTC hearing aids, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan, featuring no copay and no coinsurance for covered benefits. Routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames are covered up to specified annual benefit limits, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive services are covered up to a $4,000 annual limit with no copay and 0% to 20% coinsurance, while fluoride, implants, orthodontics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs carry no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Blue Cross Medicare Advantage Dental Premier (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers durable medical equipment, prosthetics, and diabetic equipment with no copays, though prior authorization is required. Members pay a 20% coinsurance for most equipment and supplies, while diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Diagnostic tests and procedures have a copay of $0 to $100, lab services require a $5 copay, therapeutic radiology copays start at $60, and outpatient X-rays have no copay.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Dental Premier (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, with copays ranging from $15.00 to $30.00.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Dental Premier (PPO) 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, while days 21 through 59 require a $218 daily copay, with coverage limited to the standard 100 days.
Other Services See details
Blue Cross Medicare Advantage Dental Premier (PPO) partially covers Other Services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $45 maximum benefit every three months. Acupuncture, meal benefits, and Naloxone are not covered under this plan.
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