Blue Cross Medicare Advantage Select (PPO) Medicare Advantage Plan H5959-024 • 2027
- 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
- See List
- Total Enrollment
- 0 beneficiaries
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.
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.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 50% coinsurance |
Coming soon |
| Specialist | In-network: $65 copay Out-of-network: 50% coinsurance |
Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: 50% coinsurance |
Coming soon |
| Telehealth benefit | In-network: $0-$65 copay | Coming soon |
| Routine chiropractic | Not covered | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | Not covered | Coming soon |
| Counseling services | In-network: $0 copay Out-of-network: 50% coinsurance |
Coming soon |
| Over-the-counter drug benefits | Not covered | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$300 copay Out-of-network: 50% coinsurance |
Coming soon |
| Lab services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Outpatient x-rays | In-network: $10 copay Out-of-network: 50% coinsurance |
Coming soon |
| Diagnostic tests and procedures | In-network: $0-$30 copay Out-of-network: 50% coinsurance |
Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $50 copay | Coming soon |
| 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 |
Coming soon |
| 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 |
Coming soon |
| Ground ambulance | In-network: $470 copay Out-of-network: $470 copay |
Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $65 copay Out-of-network: 50% coinsurance |
Coming soon |
| Outpatient group therapy | In-network: $65 copay Out-of-network: 50% coinsurance |
Coming soon |
| 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 |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $65 copay Out-of-network: 50% coinsurance |
Coming soon |
| Occupational therapy | In-network: $50 copay Out-of-network: 50% coinsurance |
Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 50% coinsurance |
Coming soon |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Coming soon |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Periodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Endodontics | Not covered | Coming soon |
| Restorative services | Not covered | Coming soon |
| Implant services | Not covered | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | Not covered | Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $10 copay Out-of-network: 50% coinsurance |
Coming soon |
| Contact lenses | Not covered | Coming soon |
| Eyeglass frames only | Not covered | Coming soon |
| Eyeglass lenses only | Not covered | Coming soon |
| Eyeglasses (frames & lenses) | Not covered | Coming soon |
| Upgrades | Not covered | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0-$10 copay Out-of-network: 80% coinsurance |
Coming soon |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 80% coinsurance |
Coming soon |
| Prescription hearing aids | In-network: $599-$899 copay Out-of-network: 80% coinsurance |
Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | Not covered | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
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.
Plan Availability
Blue Cross Medicare Advantage Select (H5959-024-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Blue Cross Medicare Advantage Select (PPO)
How much does plan H5959-024 cost per month?
The plan’s monthly premium is $165.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $6900.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for Blue Cross Medicare Advantage Select?
The 2027 CMS star rating for Blue Cross Medicare Advantage Select is ★0.0 out of 5.
What is the current enrollment for Blue Cross Medicare Advantage Select?
The plan has 0 enrolled beneficiaries according to CMS.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $700.00.
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 |
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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.