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Medicare Advantage with drug coverage · PPO · Plan ID H3923-044-1

Capital Blue Cross Select (PPO)

Offered by Capital Blue Cross (CAPITAL BLUE CROSS) · available in 5 counties in PA

Monthly premium$0health + drug coverage
Yearly out-of-pocket max$8,800in network
Drug deductible$700Enhanced Alternative
Star Rating★★★★ 4 out of 52027 CMS rating

Extra benefits listed in the CMS file

DentalPreventive and comprehensive dental
Visionroutine eye exam; eyewear
Hearingroutine hearing exam; hearing aids
Over-the-counter items$30 per quarter allowance
FitnessFitness benefit (gym membership or program)

Allowances and limits come from the plan's filing with CMS and are simplified here. Some benefits are only for members with certain chronic conditions. The plan's Evidence of Coverage is the final word.

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