Blue Cross Medicare Advantage Classic (PPO)
Texas Medicare Advantage Plan (2023 Plan)
Monthly Premium
Additional Coverage
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Plan Overview
Blue Cross Medicare Advantage Classic (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Texas and offered by the health insurance company Blue Cross and Blue Shield of Texas. 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
Blue Cross Medicare Advantage Classic (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $750 annual deductible and a maximum out of pocket cost sharing of $11,300 In and Out-of-network $6,700 In-network $11,300 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 Classic (PPO) are defined below.
Additional Benefits and Coverage
Blue Cross Medicare Advantage Classic (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 Classic (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Blue Cross Medicare Advantage Classic (PPO) includes coverage for the following additional benefits:
Other benefits
Plan Benefits and Coverage Details
$6,700 In-network
$11,300 Out-of-network
Medical Benefits
Doctor Services
Out-of-network: $30 copay per visit
Out-of-network: $75 copay per visit
Tests, labs, & imaging
Out-of-network: $200 copay
Out-of-network: $200 copay
Out-of-network: $400 copay
Out-of-network: $200 copay
Hospital Services
$0 per day for days 6 through 90
Out-of-network: $500 per day for days 1 and beyond
Out-of-network: $400 copay per visit
Skilled nursing facility
$196 per day for days 21 through 59
$0 per day for days 60 through 100
Out-of-network: $250 per day for days 1 and beyond
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $275 copay
Therapy services
Out-of-network: $75 copay
Out-of-network: $75 copay
Mental health services
Out-of-network: $50 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Out-of-network: $50 copay
Opioid treatment services
Other services
Out-of-network: 20% coinsurance per item
Out-of-network: 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
| Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
|---|---|---|---|
| Preferred Generic | $15.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
| Generic | $20.00 copay | ||
| Preferred Brand | $47.00 copay | ||
| Non-Preferred Drug | $100.00 copay | ||
| Specialty Tier | 29% |
Part B Drugs
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Extra Benefits
Hearing
Out-of-network: $75 copay
Out-of-network: 50% coinsurance
Out-of-network: $0 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Vision
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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