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BlueCross Blue Basic (PPO)

South Carolina Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$0
by Blue Cross Blue Shield of South Carolina

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Overview

Plan Name
BlueCross Blue Basic (PPO)
Insurance Carrier
Blue Cross Blue Shield of South Carolina
Plan Type
Medicare Advantage Plan Without Prescription Drugs
Network Type
PPO

BlueCross Blue Basic (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in South Carolina and offered by the health insurance company Blue Cross Blue Shield of South Carolina. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,900
Primary doctor visit
$0 copay
Specialist visit
$30 copay per visit
ER visit
$110 copay per visit (always covered)
Ambulance
$275 copay

BlueCross Blue Basic (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,550 In and Out-of-network $5,900 In-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 BlueCross Blue Basic (PPO) are defined below.

Additional Benefits and Coverage

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

BlueCross Blue Basic (PPO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. BlueCross Blue Basic (PPO) includes coverage for hearing, vision, dental.

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

Other benefits

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

Comparing the Quality Score of BlueCross Blue Basic (PPO) to Other Plans in South Carolina

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, BlueCross Blue Basic (PPO) received an overall government quality rating of 4.0 stars out of 5 stars.

BlueCross Blue Basic (PPO) performed better than South Carolina’s State average overall quality score of 3.8 stars.

This Plan’s 5-star Gov’t Quality Score
South Carolina State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.8
Summary rating of health plan quality
 4
 3.8
Staying healthy: screenings, tests, & vaccines
 3
 3.5
Managing chronic (long term) conditions
 3
 3.4
Member experience with health plan
 4
 3.9
Member complaints & changes in the health plan's performance
 5
 4.0
Health plan customer service
 4
 4.1

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.

BlueCross Blue Basic (PPO) received 4 stars for its health plan quality score which is better than the South Carolina State average health plan quality score of 3.8 stars.

Plan Benefits and Coverage Details

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$9,550 In and Out-of-network
$5,900 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link
http://www.scbluesmedadvantage.com
Plan Link
http://www.scbluesmedadvantage.com

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $30 copay per visit
Specialist visit
In-network: $30 copay per visit
Out-of-network: $45 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0-100 copay
Out-of-network: 20% coinsurance
Lab services
In-network: $0-50 copay
Out-of-network: 20% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0-150 copay
Out-of-network: 20% coinsurance
Outpatient x-rays
In-network: $10 copay
Out-of-network: 20% coinsurance
Emergency care
$110 copay per visit (always covered)
Urgent care
$10 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $325 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 20% per stay
Outpatient hospital coverage
In-network: $0-250 copay per visit
Out-of-network: 20% coinsurance 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: 20% per stay

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: $30 copay
Out-of-network: $45 copay
Physical therapy & speech & language therapy visit
In-network: $30 copay
Out-of-network: $45 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $35 copay
Out-of-network: 20% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $35 copay
Out-of-network: 20% coinsurance
Outpatient group therapy visit
In-network: $45 copay
Out-of-network: 20% coinsurance
Outpatient individual therapy visit
In-network: $45 copay
Out-of-network: 20% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 15-20% 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

Prescription Drug Benefits

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

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

Extra Benefits

Hearing

Hearing exam
In-network: $45 copay
Out-of-network: 20% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: $699-999 copay
Hearing aids - All types
In-network: $699-999 copay
Out-of-network: $699-999 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment
Not covered
Dental x-rays
In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Restorative services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Endodontics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Periodontics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, removable
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Prosthodontics, fixed
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Maxillofacial prosthetics
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Implant services
Not covered
Oral and maxillofacial surgery
In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Orthodontics
Not covered
Adjunctive general services
In-network: 50% coinsurance
Out-of-network: 50% coinsurance

Vision

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

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