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Secure Blue Courage (PPO) Medicare Advantage Plan H1302-004 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$5200.00In-network
Part B Giveback
−$45.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
3,774 beneficiaries
Last update:

Secure Blue Courage (PPO) Introduction

CMS Plan ID H1302-004 identifies Secure Blue Courage, a Medicare Advantage PPO plan offered by Blue Cross of Idaho. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $5200.00 in-network maximum out-of-pocket.

Plan Benefits

Secure Blue Courage includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H1302-004.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $45 copay		 In-network: $0 copay
Out-of-network: $45 copay
Specialist In-network: $40 copay
Out-of-network: $45 copay		 In-network: $40 copay
Out-of-network: $45 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Telehealth benefit In-network: $0-$40 copay In-network: $0-$40 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits Not covered Not covered
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$200 copay
Out-of-network: 25% coinsurance		 In-network: $0-$200 copay
Out-of-network: 25% coinsurance
Lab services In-network: $0 copay
Out-of-network: 25% coinsurance		 In-network: $0 copay
Out-of-network: 25% coinsurance
Outpatient x-rays In-network: $15 copay
Out-of-network: 25% coinsurance		 In-network: $15 copay
Out-of-network: 25% coinsurance
Diagnostic tests and procedures In-network: $30 copay, 10% coinsurance
Out-of-network: 25% coinsurance		 In-network: $30 copay, 10% coinsurance
Out-of-network: 25% coinsurance

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $100 copay
Worldwide emergency care Coming soon $0 copay
Urgent care $50 copay $40 copay
Inpatient hospital care In-network:
Tier 1
$350 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
$350 per day for days 1-10
$0 per day for days 11-90
$0 per stay		 In-network:
Tier 1
$350 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
$350 per day for days 1-10
$0 per day for days 11-90
$0 per stay
Skilled Nursing Facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-55
$0 per day for days 56-100
Out-of-network:
$100 per day for days 1-12
$221 per day for days 13-100
$0 per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-55
$0 per day for days 56-100
Out-of-network:
$100 per day for days 1-12
$218 per day for days 13-100
$0 per stay
Ground ambulance In-network: $275 copay
Out-of-network: $275 copay		 In-network: $275 copay
Out-of-network: $275 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $40 copay
Out-of-network: 25% coinsurance		 In-network: $40 copay
Out-of-network: 25% coinsurance
Outpatient group therapy In-network: $40 copay
Out-of-network: 25% coinsurance		 In-network: $40 copay
Out-of-network: 25% coinsurance
Inpatient psychiatric hospital care In-network:
Tier 1
$350 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
$350 per day for days 1-10
$0 per day for days 11-90
$0 per stay		 In-network:
Tier 1
$350 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
$350 per day for days 1-10
$0 per day for days 11-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $40 copay
Out-of-network: $45 copay		 In-network: $40 copay
Out-of-network: $45 copay
Occupational therapy In-network: $40 copay
Out-of-network: $45 copay		 In-network: $40 copay
Out-of-network: $45 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay
Out-of-network: 30% coinsurance		 In-network: $0 copay
Out-of-network: 30% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 30% coinsurance		 In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 30% coinsurance		 In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 0%-30% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Endodontics In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Restorative services In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Implant services In-network: 50% coinsurance
Out-of-network: 50% coinsurance		 In-network: $300 copay
Out-of-network: 50% coinsurance
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $20 copay
Out-of-network: 50% coinsurance		 In-network: $20 copay
Out-of-network: 50% coinsurance
Contact lenses In-network: $0-$35 copay
Out-of-network: $0-$35 copay		 In-network: $0-$35 copay
Out-of-network: $0-$35 copay
Eyeglass frames only Not covered Not covered
Eyeglass lenses only Not covered Not covered
Eyeglasses (frames & lenses) In-network: $35 copay
Out-of-network: 50% coinsurance		 In-network: $35 copay
Out-of-network: 50% coinsurance
Upgrades In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 90% coinsurance		 In-network: $0 copay
Out-of-network: $45 copay
Fitting/evaluation In-network: $0 copay
Out-of-network: 90% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Prescription hearing aids In-network: $499-$999 copay
Out-of-network: 90% coinsurance		 In-network: $499-$999 copay
Out-of-network: $499-$999 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Secure Blue Courage as a Part B benefit.

Prescription Drug Coverage

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

CMS 5-Star Performance Ratings (Contract ID: H1302)

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.

2027 Medicare Star Ratings for Contract H1302
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 Not enough data available
Drug Plan Customer Service Not enough data available
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan Not enough data available
Drug Safety and Accuracy of Drug Pricing Not enough data available

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Secure Blue Courage (PPO)

What is the monthly premium for Secure Blue Courage (PPO)?

The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.

What is the annual out-of-pocket maximum (MOOP) for this plan?

The annual in-network MOOP is $5200.00 for 2027. After this limit is reached, covered in-network services are fully paid.

What is the total enrollment for plan H1302-004?

The plan has 3,774 enrolled beneficiaries according to CMS.

What is the Part D deductible for plan H1302-004?

For 2027, the prescription drug deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Blue Cross of Idaho (official source) http://medicare.bcidaho.com October 4, 2026
Medicare.gov Compare types of Medicare Advantage Plans 25 May, 2025
Medicare.gov Joining a plan 25 May, 2025
Medicare.gov Compare Original Medicare & Medicare Advantage 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.