2027 Medicare Advantage plan
Blue Advantage Choice (PPO): 2027 benefits and costs
Blue Cross and Blue Shield of Alabama PPO
CMS plan ID: H0104-016-0 · Plan year: 2027
Blue Advantage Choice (PPO) is a 2027 Medicare Advantage plan offered by Blue Cross and Blue Shield of Alabama. It is listed in Alabama.
2027 plan costs at a glance
- Organization
- Blue Cross and Blue Shield of Alabama
- Plan organization
- BLUE CROSS AND BLUE SHIELD OF ALABAMA
- Parent company
- BlueCross BlueShield of Alabama
- Plan type
- PPO
- Part C premium
- $0.00
- Part D premium
- $0.00
- Prescription drug coverage
- Yes
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- $450.00
Applies to out-of-network Medicare-covered services and certain in-network Medicare-covered services and certain in-network supplemental services; out-of-network $0 preventive care is exempt.
- In-network medical maximum
- $7,150.00
- Combined in/out-of-network medical maximum
- $10,000.00
- Out-of-network medical maximum
- Not applicable
2027 benefit summary
Doctor visits and medical care
Plan-level deductibles may still apply when a service-specific deductible is listed as No.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $10.00 copay
| 50% coinsurance
| |
| Specialist visit | $15.00 to $40.00 copay
| 50% coinsurance
|
|
| Telehealth | $10.00 to $155.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $130.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $10.00 to $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 50% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Kidney disease education services | $0
| 50% coinsurance
|
|
| Medicare-covered chiropractic | $15.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $35.00 copay
| 50% coinsurance
|
|
| Other health professionals | $15.00 to $40.00 copay
| 50% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–7: $410.00 copay per day Days 8–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–7: $335.00 copay per day Days 8–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $10.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $440.00 copay
| 50% coinsurance
| |
| Hospital observation services | $0.00 to $440.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $0.00 to $385.00 copay
| 50% coinsurance
|
|
| Outpatient blood | $0
| 50% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0
| 50% coinsurance
|
|
| Laboratory services | $0
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $340.00 copay
| 50% coinsurance
|
|
| Therapeutic radiology | $85.00 copay
| 50% coinsurance
|
|
| X-rays | $20.00 copay
| 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $155.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $155.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $10.00 to $40.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $10.00 to $40.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $0
| 50% coinsurance
|
|
| Mental health, individual sessions | $10.00 to $40.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $10.00 to $40.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $10.00 to $40.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $10.00 to $40.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $40.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $40.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $40.00 copay
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $40.00 copay
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $35.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $25.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $355.00 copay
| $355.00 copay
|
|
| Air ambulance | $355.00 copay
| $355.00 copay
|
|
| Durable medical equipment | 11% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 11% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 11% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | $0
| 50% coinsurance
|
|
| Diabetic shoes and inserts | $0
| 50% coinsurance
|
|
| Diabetic monitors | $0
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $40.00 copay | 50% coinsurance
| |
| Oral examsAdditional plan benefit | $0 | $0
| |
| Dental X-raysAdditional plan benefit | $0 | $0
| |
| Other diagnostic dentalAdditional plan benefit | $0 | $0
| |
| Dental cleaningAdditional plan benefit | $0 | $0
| |
| FluorideAdditional plan benefit | $0 | $0
| |
| Other preventive dentalAdditional plan benefit | $0 | $0
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $15.00 to $40.00 copay
| 50% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0 | 50% coinsurance
|
|
| Medicare-covered eyewear | $0
| 50% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0 | 50% coinsurance
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 | 50% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $10.00 copay
| 50% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0 | 80% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 | 80% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $499.00 to $999.00 copay
| 80% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
These benefit details are not listed.
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Enhanced Disease ManagementAdditional plan benefit | Out-of-network | 80% coinsurance
|
|
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | 80% coinsurance
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 50% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | 50% coinsurance
|
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.
Standard retail costs
| Drug tier | 30 days | 100 days |
|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 |
| Tier 2Generic | $0.00 | $0.00 |
| Tier 3Preferred Brand | 23% | 23% |
| Tier 4Non-Preferred Drug | 28% | 28% |
| Tier 5Specialty Tier | 25% | Not listed |
Mail-order and other pharmacies
Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.
Standard mail order costs
| Drug tier | 30 days | 100 days |
|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 |
| Tier 2Generic | $0.00 | $0.00 |
| Tier 3Preferred Brand | 23% | 23% |
| Tier 4Non-Preferred Drug | 28% | 28% |
| Tier 5Specialty Tier | 25% | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $0.00 |
| Tier 3Preferred Brand | 23% |
| Tier 4Non-Preferred Drug | 28% |
| Tier 5Specialty Tier | 25% |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $0.00 |
| Tier 3Preferred Brand | 23% |
| Tier 4Non-Preferred Drug | 28% |
| Tier 5Specialty Tier | 25% |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
- Initial-coverage prices also apply to drugs exempt from the deductible
- Yes
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 67 county listings across 1 state or territory
Alabama
- Autauga, Alabama
- Baldwin, Alabama
- Barbour, Alabama
- Bibb, Alabama
- Blount, Alabama
- Bullock, Alabama
- Butler, Alabama
- Calhoun, Alabama
- Chambers, Alabama
- Cherokee, Alabama
- Chilton, Alabama
- Choctaw, Alabama
- Clarke, Alabama
- Clay, Alabama
- Cleburne, Alabama
- Coffee, Alabama
- Colbert, Alabama
- Conecuh, Alabama
- Coosa, Alabama
- Covington, Alabama
- Crenshaw, Alabama
- Cullman, Alabama
- Dale, Alabama
- Dallas, Alabama
- DeKalb, Alabama
- Elmore, Alabama
- Escambia, Alabama
- Etowah, Alabama
- Fayette, Alabama
- Franklin, Alabama
- Geneva, Alabama
- Greene, Alabama
- Hale, Alabama
- Henry, Alabama
- Houston, Alabama
- Jackson, Alabama
- Jefferson, Alabama
- Lamar, Alabama
- Lauderdale, Alabama
- Lawrence, Alabama
- Lee, Alabama
- Limestone, Alabama
- Lowndes, Alabama
- Macon, Alabama
- Madison, Alabama
- Marengo, Alabama
- Marion, Alabama
- Marshall, Alabama
- Mobile, Alabama
- Monroe, Alabama
- Montgomery, Alabama
- Morgan, Alabama
- Perry, Alabama
- Pickens, Alabama
- Pike, Alabama
- Randolph, Alabama
- Russell, Alabama
- Shelby, Alabama
- St. Clair, Alabama
- Sumter, Alabama
- Talladega, Alabama
- Tallapoosa, Alabama
- Tuscaloosa, Alabama
- Walker, Alabama
- Washington, Alabama
- Wilcox, Alabama
- Winston, Alabama