Blue Cross Medicare Advantage Select (PPO) Medicare Advantage Plan H5959-024 • 2027 • Douglas County, MN
- Monthly Premium
- $165.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6900.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Douglas County, MN
- Local Enrollment
- 0 beneficiaries in Douglas County
Blue Cross Medicare Advantage Select (PPO) Introduction
CMS Plan ID H5959-024 identifies Blue Cross Medicare Advantage Select, a Medicare Advantage PPO plan offered by Blue Cross and Blue Shield of Minnesota. The plan uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $165.00 monthly premium, $0.00 medical deductible, and $6900.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $700.00.
This plan is available to eligible beneficiaries who live in Douglas County, Minnesota. CMS reports local enrollment of 0 beneficiaries for this plan in Douglas County. New members can contact the plan at (855)579-7658 (TTY 711) for help and additional plan information.
Compare Similar Plans in Douglas County
Compare this plan with the two most-enrolled PPO plans available in Douglas County, Minnesota. Enrollment is based on CMS local enrollment data.
| Plan Detail | Blue Cross Medicare Advantage Select | Blue Cross Medicare Advantage Freedom Blue | Medica Advantage Select |
|---|---|---|---|
| CMS Plan ID | H5959-024-0 |
H5959-018-0 |
H8889-002-0 |
| Local Enrollment | 0 | 606 | 318 |
| Monthly Premium | $165.00 | $0.00 | $122.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $6,900.00 | $6,900.00 | $7,150.00 |
| Part B Giveback | Not offered | −$145.00 reduction | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $65 copay | $40 copay | $60 copay |
| Part D Deductible | $700.00 | Not Applicable | $420.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $10 copay | $20 copay | $0 copay |
| Hearing | $0-$10 copay | $0-$20 copay | $0 copay |
Plan Benefits
Blue Cross Medicare Advantage Select has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5959-024.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5959-024-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 50% coinsurance - Specialist
- In-network: $65 copay
Out-of-network: 50% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Telehealth benefit
- In-network: $0-$65 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$300 copay
Out-of-network: 50% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Outpatient x-rays
- In-network: $10 copay
Out-of-network: 50% coinsurance - Diagnostic tests and procedures
- In-network: $0-$30 copay
Out-of-network: 50% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $50 copay
- Inpatient hospital care
- In-network:
Tier 1
$450 per day for days 1-5
$0 per day for days 6-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Out-of-network:
50% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay - Ground ambulance
- In-network: $470 copay
Out-of-network: $470 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $65 copay
Out-of-network: 50% coinsurance - Outpatient group therapy
- In-network: $65 copay
Out-of-network: 50% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$450 per day for days 1-5
$0 per day for days 6-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Out-of-network:
50% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $65 copay
Out-of-network: 50% coinsurance - Occupational therapy
- In-network: $50 copay
Out-of-network: 50% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 50% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $10 copay
Out-of-network: 50% coinsurance - Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0-$10 copay
Out-of-network: 80% coinsurance - Fitting/evaluation
- In-network: $0 copay
Out-of-network: 80% coinsurance - Prescription hearing aids
- In-network: $599-$899 copay
Out-of-network: 80% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Blue Cross Medicare Advantage Select as a Part B benefit.
Prescription Drug Coverage
Blue Cross Medicare Advantage Select includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $22.50 |
| Supplemental Part D Premium: | $$20.70 |
| Total Part D Premium: | $43.20 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $22.50 |
| Low-Income Subsidy Premium: | $20.70 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Cross and Blue Shield of Minnesota starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Blue Cross Medicare Advantage Select may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 23% coinsurance | Coming soon |
| Non-Preferred Drug | 28% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5959)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Blue Cross and Blue Shield of Minnesota
- Website
- Blue Cross and Blue Shield of Minnesota Plan Page
- Providers
- Blue Cross and Blue Shield of Minnesota Providers Page
- Formulary
- Blue Cross and Blue Shield of Minnesota Formulary Page
- Pharmacy
- Blue Cross and Blue Shield of Minnesota Pharmacy Page
- New Member Health Plan Help
- (855)579-7658
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (855)579-7658
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Cross and Blue Shield of Minnesota (official source) | http://www.bluecrossmn.com/medicare | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.