Blue Cross Medicare Advantage Protect (PPO) Medicare Advantage Plan H8634-028 • 2026 • Adair County, OK

Blue Cross Medicare Advantage Protect Overview

Plan Details for Blue Cross Medicare Advantage Protect

This Medicare Advantage Preferred Provider Organization (PPO) plan provides access to Medicare-approved providers and covers Medicare Part A and Part B services. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: 50% coinsurance, specialist visits come with a $55 copay | Out-of-network: 50% coinsurance, urgent care services carry a $40 copay, and ambulance transportation is $250 copay | Out-of-network: $250 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $7350.00. Once this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H8634-028. Cost-sharing details for key services are provided below.

Cost-Sharing Overview

Blue Cross Medicare Advantage Protect includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H8634-028.

Certain preventive services are covered 100% by Blue Cross Medicare Advantage Protect as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

Medicare Plan Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.