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Blue Cross Medicare Advantage Preferred (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Preferred (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 Preferred (PPO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Preferred (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in Multi TX Premium PPO (NEW). This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Preferred (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 Preferred (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 Preferred (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $110.00. 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 $450.00 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 $12500.00 (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 $12500.00 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 Preferred (PPO) plan features an annual drug deductible of $450. Under this plan, Tier 1 preferred generic drugs have no copay when filled through preferred pharmacies or preferred mail order services. For Tier 2 generic prescriptions, costs remain low with a copay starting at just $1 at preferred locations. For brand-name and specialty medications, costs are determined by coinsurance percentages. Tier 3 preferred brand drugs carry a 17% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs require 37% coinsurance. Specialty drugs in Tier 5 incur a 27% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Cross Medicare Advantage Preferred (PPO) plan offers comprehensive medical coverage with predictable costs, featuring a low $7 copay for primary care visits and no copay for telehealth services and preventive care. Specialist visits require a $47 copay with no coinsurance, while emergency room visits incur a $100 copay that is waived upon hospital admission. For inpatient hospital stays, there is a $375 daily copay for the first six days, after which there is no copay. This plan also partially covers routine dental, vision, and hearing services, offering no copay for routine exams, cleanings, and diagnostic X-rays. Skilled nursing facility care is covered with no copay for the first 20 days, and home health services are available with no copay or coinsurance. Please note that certain supplemental benefits, such as over-the-counter items, meal benefits, and transportation services, are not covered.
Inpatient Hospital See details
Blue Cross Medicare Advantage Preferred (PPO) covers inpatient hospital care with no coinsurance, requiring a $375 daily copay for days 1 to 6 of acute stays (no copay for days 7 and beyond) and a $270 daily copay for days 1 to 6 of psychiatric stays (no copay for days 7 to 90). Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Blue Cross Medicare Advantage Preferred (PPO) feature no coinsurance and copays ranging from no copay to $390 for outpatient hospital services, and no copay or coinsurance for ambulatory surgical center services. Outpatient substance abuse sessions require a $75 copay with no coinsurance, while outpatient blood services have a 20% coinsurance and no copay. Observation services incur a $375 copay per stay with no coinsurance, with prior authorization required for several of these covered services.
Partial Hospitalization See details
Blue Cross Medicare Advantage Preferred (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Preferred (PPO) covers ambulance services with prior authorization, requiring a $275 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Cross Medicare Advantage Preferred (PPO) with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within 3 days. Urgently needed services have a $40 copay with no coinsurance, and while worldwide emergency and urgent care are covered with a $100 copay and no coinsurance, worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Preferred (PPO) covers primary care physician services for a $7 copay and specialist visits for a $47 copay, both with no coinsurance. Additional telehealth benefits are available with no copay and no coinsurance, though podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by Blue Cross Medicare Advantage Preferred (PPO) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and kidney disease education. However, several services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Preferred (PPO), featuring Medicare-covered exams for a $45 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are covered with a copay of $699 to $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Preferred (PPO) provides partially covered vision services, which include routine eye exams with no copay and no coinsurance, and eyewear with a $40 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 Preferred (PPO) partially covers dental services, offering Medicare-covered dental care for a $45.00 copay and no coinsurance. Preventive services like oral exams (2 per year), cleanings (2 per year), and dental X-rays (1 per year) are covered with no copay and no coinsurance, but fluoride, restorative, endodontic, periodontic, prosthodontic, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Preferred (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Blue Cross Medicare Advantage Preferred (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Blue Cross Medicare Advantage Preferred (PPO) covers durable medical equipment, prosthetics, and diabetic services with no copay and 20% coinsurance, though diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Preferred (PPO) under prior authorization. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $100 copay for tests, while radiological services require a minimum 20% coinsurance for therapeutic treatments and no copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Blue Cross Medicare Advantage Preferred (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Blue Cross Medicare Advantage Preferred (PPO) require prior authorization and feature no copay and no coinsurance for covered services. Although some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Preferred (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and 60 to 100, and a $218 daily copay for days 21 to 59. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Other services are not covered under the Blue Cross Medicare Advantage Preferred (PPO) plan, meaning supplemental benefits such as acupuncture, over-the-counter (OTC) items, and meal benefits are not available.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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