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Blue Cross Medicare Advantage Optimum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Optimum (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 Optimum (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Optimum (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in OK $High 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 Optimum (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 Optimum (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 Optimum (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $159.00. 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 $300.00 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 $6200.00 (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 $6200.00 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 Optimum (PPO) plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, starting with a low $1 copay for a one-month supply at preferred locations. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brands require an 18% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 40% coinsurance. Specialty medications in Tier 5 incur a 29% coinsurance for a one-month supply across all pharmacy types.
Additional Benefits
The Blue Cross Medicare Advantage Optimum (PPO) plan offers affordable coverage with no copays or coinsurance for primary care visits, routine vision exams, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $250 daily copay for days one through six, while specialist visits require a $22 to $45 copay. Emergency room visits carry a $120 copay, which is waived if admitted, and urgent care services require a $40 copay. For ancillary care, routine dental cleanings have no copay, while comprehensive dental services require 0% to 20% coinsurance up to a $750 annual limit. Prescription hearing aids are covered with a copay of $699 to $999, and covered eyewear requires a $35 copay. Additionally, diagnostic x-rays have no copay, while durable medical equipment and dialysis services feature a 20% coinsurance with no copays.
Inpatient Hospital See details
Blue Cross Medicare Advantage Optimum (PPO) covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 to 6 of acute stays and a $225 daily copay for days 1 to 7 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Blue Cross Medicare Advantage Optimum (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $300 for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Optimum (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Optimum (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Cross Medicare Advantage Optimum (PPO) with a $120 copay (waived if admitted to the hospital within 3 days) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $120 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Optimum (PPO) covers primary care and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services are covered with no coinsurance and copays ranging from $22 to $45, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Optimum (PPO) with no copay and no coinsurance for annual exams, kidney disease education, fitness benefits, and select screenings. However, the benefit is only partially covered as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services covered by Blue Cross Medicare Advantage Optimum (PPO) require no coinsurance, offering Medicare-covered exams for a $40 copay, alongside one annual routine exam and unlimited fitting evaluations for no copay. Prescription hearing aids are partially covered with a copay of $699 to $999 for up to two aids per year, though OTC hearing aids and inner, outer, or over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Optimum (PPO) with no deductibles, featuring routine eye exams with no copay and no coinsurance, and covered eyewear with a $35 copay and no coinsurance. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Optimum (PPO) offers partially covered dental services, including Medicare-covered dental for a $35 copay and no coinsurance, and select preventive care like exams and cleanings with no copay or coinsurance. Other comprehensive services are covered up to a $750 annual limit with no copay and 0% to 20% coinsurance, while implants, orthodontics, fluoride, and other diagnostic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Optimum (PPO) with no copay, though prior authorization is required. Covered Part B chemotherapy, radiation, and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Blue Cross Medicare Advantage Optimum (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Blue Cross Medicare Advantage Optimum (PPO) covers durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment with no copays, though prior authorization is required. A 20% coinsurance applies to most of these items, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Optimum (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Outpatient x-rays and diagnostic radiological services have no copay, while lab services carry a $5 copay, therapeutic radiology starts at a $45 copay, and diagnostic procedures range from no copay to a $100 copay.
Home Health Services See details
Blue Cross Medicare Advantage Optimum (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Optimum (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $15 copay), and SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Optimum (PPO) with no coinsurance, offering no copay for days 1 to 20 and days 50 to 100, and a $218 daily copay for days 21 to 49. Prior authorization is required, but a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100-day benefit are not covered.
Other Services See details
Other Services are partially covered by Blue Cross Medicare Advantage Optimum (PPO), which features over-the-counter (OTC) items with no copay and no coinsurance up to $25 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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