Capital Blue Cross Basic (PPO) H3923-049-001

Capital Blue Cross Basic (PPO) (Local PPO) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Published supplemental benefits include dental ($2,000/yr preventive dental allowance), vision ($125/yr eyewear allowance), hearing ($499–$999 copay per hearing aid), and over-the-counter (OTC) ($30/quarter OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

The published 2027 monthly plan premium for Capital Blue Cross Basic (PPO) (Local PPO) is $28. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $550. The listed Part D deductible is $700. The in-network medical out-of-pocket maximum is $9,800; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $35. These figures are plan data, not a personal yearly-cost estimate.

CMS lists Capital Blue Cross Basic (PPO) (Local PPO) as a Local PPO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

The current plan record for Capital Blue Cross Basic (PPO) (Local PPO) does not include tier-level formulary costs. The listed Part D deductible is $700. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.

The current plan record for Capital Blue Cross Basic (PPO) (Local PPO) lists dental ($2,000/yr preventive dental allowance), vision ($125/yr eyewear allowance), and hearing ($499–$999 copay per hearing aid). It also lists over-the-counter (OTC) ($30/quarter OTC allowance). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

Capital Blue Cross Basic (PPO) (Local PPO) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.