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Read more →Medicare PPO Blue EssentialRx (PPO)
by Blue Cross Blue Shield of Massachusetts
2026 Medicare Advantage plan available in Massachusetts
Plan ID H2230-019-0
Additional coverage:
RxHearingVisionDental
Medicare Advantage PPO 4.5 Overall
Monthly plan premium $59 / mo
Annual deductible $0 / yr
Max out-of-pocket · in-network $9,250 / yr
Drug deductible $615 / yr
4.5 Overall Government Star Rating 2026 · out of 5 stars
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Plan Overview
Medicare PPO Blue EssentialRx (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Massachusetts and offered by the health insurance company Blue Cross Blue Shield of Massachusetts. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.
Plan Name Medicare PPO Blue EssentialRx (PPO)
Insurance Carrier Blue Cross Blue Shield of Massachusetts
Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type PPO
Cost Summary
Medicare PPO Blue EssentialRx (PPO) has a monthly premium cost of $59 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $9,250. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $59 / mo
Health portion of premium $25
Drug portion of premium $34
Annual Deductible $0 / yr
Max Out-of-Pocket · in-network $9,250 / yr
Primary doctor visit $0 copay
Specialist visit $0-$55 copay
ER visit $115 copay
Ambulance $400 copay
Additional Benefits and Coverage
Medicare PPO Blue EssentialRx (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Medicare PPO Blue EssentialRx (PPO) includes coverage for hearing, vision, dental.
Part D Prescription Drug Coverage Yes
Dental Yes
Vision Yes
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Not covered
Over-the-counter drug benefits Not covered
In-home support services Not covered
Home & bathroom safety devices Not covered
Meals for short duration Limited coverage
Annual physical exams Limited coverage
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Specialist visit In-network: $0-$55 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Tests, labs & imaging
Diagnostic tests & procedures In-network: $0-$20 copay
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Lab services In-network: $0-$20 copay
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Diagnostic radiology services (like MRI) In-network: $375 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Outpatient x-rays In-network: $15 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Emergency care $115 copay
Urgent care $0-$40 copay
Hospital Services
Inpatient hospital coverage In-network:
Tier 1
$388 per day for days 1-7
$0 per day for days 8-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Out-of-network:
50% per stay
Tier 1
$388 per day for days 1-7
$0 per day for days 8-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Out-of-network:
50% per stay
Outpatient hospital coverage In-network: 30% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Skilled nursing facility
Skilled nursing facility In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
50% per stay
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
50% per stay
Preventive services
Preventive services In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Ambulance
Ground ambulance In-network: $400 copay
Out-of-network: $400 copay
Out-of-network: $400 copay
Therapy services
Occupational therapy visit In-network: $35 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Physical therapy & speech & language therapy visit In-network: $35 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist In-network: $50 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Outpatient individual therapy with a psychiatrist In-network: $50 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Outpatient group therapy visit In-network: $50 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Outpatient individual therapy visit In-network: $0-$50 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Opioid treatment services
Opioid treatment services Covered
Other services
Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Diabetes supplies In-network: $0 copay
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Preferred Generic $10.00 copay $0 copay
Generic $20.00 copay $0 copay
Preferred Brand 25% coinsurance $0 copay
Non-Preferred Drug 25% coinsurance $0 copay
Specialty Tier 25% coinsurance $0 copay
Part B drugs
Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Medicare star rating
Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Medicare PPO Blue EssentialRx (PPO) earned an overall rating of 4.5 stars — better than Massachusetts's state average of 4.0 stars.
Rating category This plan State average
Overall star rating ★ 4.5 4.0
Health plan quality
Summary rating of health plan quality ★ 4.5 4.0
Staying healthy: screenings, tests & vaccines ★ 5.0 4.1
Managing chronic (long-term) conditions ★ 4.0 3.5
Member experience with health plan ★ 3.0 3.7
Member complaints & changes in performance ★ 5.0 4.4
Health plan customer service ★ 4.0 4.0
Drug plan quality
Summary rating of drug plan quality ★ 4.5 4.0
Drug plan customer service ★ 4.0 4.3
Member complaints & changes in performance ★ 5.0 4.3
Member experience with the drug plan ★ 3.0 3.4
Drug safety & accuracy of drug pricing ★ 4.0 3.8
Extra Benefits
Hearing
Hearing exam In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Fitting/evaluation In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Hearing aids - prescription In-network: $699-$999 copay
Out-of-network: $699-$999 copay
Out-of-network: $699-$999 copay
Hearing aids - over the counter Not covered
Preventive dental
Oral exam In-network: $0 copay
Out-of-network: $60 copay
Out-of-network: $60 copay
Cleaning In-network: $0 copay
Out-of-network: $60 copay
Out-of-network: $60 copay
Fluoride treatment Not covered
Dental x-rays In-network: $0 copay
Out-of-network: $60 copay
Out-of-network: $60 copay
Comprehensive dental
Restorative services In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Periodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, removable In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, fixed In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Maxillofacial prosthetics In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Implant services In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Oral and maxillofacial surgery In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Orthodontics Not covered
Adjunctive general services In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Vision
Routine eye exam In-network: $0 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Contact lenses In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Upgrades Not covered
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