Blue Cross Medicare Advantage Access (PPO)

New Mexico Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$124
by Blue Cross and Blue Shield of New Mexico

Additional Coverage

HearingVision

Overall Government Star Rating

 3.0
out of 5 stars

Ready to Enroll Online?


Plan Name
Blue Cross Medicare Advantage Access (PPO)
Insurance Carrier
Blue Cross and Blue Shield of New Mexico
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

Blue Cross Medicare Advantage Access (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in New Mexico and offered by the health insurance company Blue Cross and Blue Shield of New Mexico. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$124
Annual Deductible
$0
Max Out-of-Pocket
$3,750
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$130 copay per visit (always covered)
Ambulance
$275 copay

Blue Cross Medicare Advantage Access (PPO) has a monthly premium cost of $124 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,700 In and Out-of-network $3,750 In-network $5,700 Out-of-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Blue Cross Medicare Advantage Access (PPO) are defined below.

Yes
Part D Prescription Drug Coverage
No
Dental
Yes
Vision
Yes
Hearing

Blue Cross Medicare Advantage Access (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Cross Medicare Advantage Access (PPO) includes coverage for hearing, vision.

Medicare Advantage health plans can offer even more additional benefits. Blue Cross Medicare Advantage Access (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Blue Cross Medicare Advantage Access (PPO) received an overall government quality rating of 3.0 stars out of 5 stars.

Blue Cross Medicare Advantage Access (PPO) performed worse than New Mexico’s State average overall quality score of 3.5 stars.

This Plan’s 5-star Gov’t Quality Score
New Mexico State Average Score
Overall Government 5 Star Quality Rating
 3.0
 3.5
Summary rating of health plan quality
 3
 3.5
Staying healthy: screenings, tests, & vaccines
 4
 3.9
Managing chronic (long term) conditions
 2
 3.4
Member experience with health plan
 3
 3.3
Member complaints & changes in the health plan's performance
 4
 4.0
Health plan customer service
 4
 4.0
Summary rating of drug plan quality
 3
 3.5
Drug plan customer service
 5
 4.2
Member complaints & changes in the drug plan's performance
 4
 3.8
Member experience with the drug plan
 1
 3.2
Drug safety & accuracy of drug pricing
 3
 3.0

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Blue Cross Medicare Advantage Access (PPO) received 3 stars for its health plan quality score which is worse than the New Mexico State average health plan quality score of 3.5 stars.

Blue Cross Medicare Advantage Access (PPO) received 3 stars for its drug plan quality score which is worse than the New Mexico State average drug plan quality score of 3.5 stars.


Monthly Premium
$124
Health Portion of Premium
$105
Drug Portion of Premium
$19
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,700 In and Out-of-network
$3,750 In-network
$5,700 Out-of-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
No

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0 copay
Out-of-network: $0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0-200 copay
Out-of-network: $0-200 copay
Outpatient x-rays
In-network: $125 copay
Out-of-network: $125 copay
Emergency care
$130 copay per visit (always covered)
Urgent care
$50 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $0 copay per stay
Out-of-network: $0 copay per stay
Outpatient hospital coverage
In-network: $325 copay per visit
Out-of-network: $325 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 100
Out-of-network: $0 per day for days 0 through 20
$214 per day for days 21 through 100
$0 per day for days 101 through 365

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $275 copay
Out-of-network: $275 copay

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: 20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$18.00 copay$0 copay
Generic$20.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug49% coinsurance$0 copay
Specialty Tier25% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $699-999 copay
Out-of-network: $699-999 copay

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Ready to Enroll Online?

Please Support Our Sponsor

Advertisement

Medicare Health Plans

Get Advice & Sign Up Help

TTY 711

Speak with a Licensed Insurance Agent

Mon-Fri: 8am - 10pm ET
Sat-Sun: 8am - 9pm ET

Medicare65quote

  • Medicare Advantage Plans
  • Medicare Prescription Drug Plans
  • Medicare Supplement Insurance Plans

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! See www.medicare65quote.com for our Third-Party Marketing Organization disclaimer.
Insurance Ad -No Government Affiliation

Related Articles
Best New Mexico Medicare Advantage Health Insurance Companies for 2025

In this article we rank New Mexico Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

Read more →