Medicare PPO Blue PlusRx (PPO) 2026 Plan Details for Franklin County, Massachusetts Residents
Medicare PPO Blue PlusRx (PPO) 2026 Plan Details for Franklin County, Massachusetts Residents
Choosing the right Medicare Advantage plan in Franklin County is crucial for your healthcare needs in 2026. With Medicare PPO Blue PlusRx (PPO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data, there are approximately 3,995 members enrolled in this plan, 96 in Franklin County.
Medicare PPO Blue PlusRx Overview
| Plan ID H2230-002-0 Overview | |
|---|---|
| Health Plan ID: | H2230-002-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $300.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $4200.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $200.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Franklin County, MA |
| Insured By: | Blue Cross Blue Shield of Massachusetts |
Why Choose Medicare PPO Blue PlusRx?
This Medicare Advantage MAPD PPO plan combines hospital, medical, and prescription drug coverage with the flexibility to see providers in or out of the plan’s network. With a monthly premium of $300.00, Medicare PPO Blue PlusRx includes all the core benefits of Medicare Part A and Part B, plus built-in drug coverage to help manage your prescriptions. The annual Part D deductible is $200.00.
Primary care visits have a $0 copay | Out-of-network: $45 copay, while seeing a specialist comes with a $0-$40 copay | Out-of-network: $45 copay. Urgent care services carry a $0-$45 copay, and ground ambulance transportation is $200 copay | Out-of-network: $200 copay. These costs apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $4200.00 — and once that’s reached, all in-network services are fully covered for the rest of the year.
This plan is registered with CMS under ID H2230-002-0. Below, you’ll find a summary of cost sharing for key services. Still have questions? Check the FAQ section for more details.
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Out-of-Pocket Expenses
Medicare PPO Blue PlusRx has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H2230-002-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $45 copay |
| Specialist: | In-network: $0-$40 copay | Out-of-network: $45 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$40 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health education: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Counseling services: | Not covered |
| Over the counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $140 copay |
| Wordwide emergency care: | $75 copay |
| Urgent care: | $0-$45 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $250 per day for days 1-7 | $0 per day for days 8-90 | $0 Lifetime Reserve Days for days 1-60 | $0 per stay | Out-of-network: | 20% per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $100 per day for days 21-44 | $0 per day for days 45-100 | Out-of-network: | 20% per stay |
| Ground ambulance: | In-network: $200 copay | Out-of-network: $200 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $25 copay | Out-of-network: 20% coinsurance |
| Outpatient group therapy: | In-network: $25 copay | Out-of-network: 20% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $250 per day for days 1-7 | $0 per day for days 8-90 | $0 Lifetime Reserve Days for days 1-60 | $0 per stay | Out-of-network: | 20% per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20 copay | Out-of-network: 20% coinsurance |
| Occupational therapy: | In-network: $20 copay | Out-of-network: 20% coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Durable medical equipment: | In-network: 10% coinsurance | Out-of-network: 20% coinsurance |
| Prosthetics: | In-network: 10% coinsurance | Out-of-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $150 copay | Out-of-network: 40% coinsurance |
| Lab services: | In-network: $0-$10 copay | Out-of-network: 20% coinsurance |
| Outpatient x-rays: | In-network: $10 copay | Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$10 copay | Out-of-network: 20% coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-10% coinsurance | Out-of-network: 10% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-10% coinsurance | Out-of-network: 10% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $45 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $45 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $45 copay |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $45 copay |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $45 copay |
| Prescription hearing aids: | In-network: $699-$999 copay | Out-of-network: $699-$999 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $45 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| 'Wigs for chemotherapy hair loss: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Medicare PPO Blue PlusRx as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Medicare PPO Blue PlusRx includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $124.40 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $124.40 |
| Low-Income Premium Subsidy: | $35.76 |
| Low-Income Premium Subsidy Paid by CMS: | $35.80 |
| Low-Income Subsidy Premium: | $88.60 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $200.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Cross Blue Shield of Massachusetts starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Medicare PPO Blue PlusRx 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 | $5.00 copay | Coming soon |
| Preferred Brand | $42.00 copay | Coming soon |
| Non-Preferred Drug | $95.00 copay | Coming soon |
| Specialty Tier | 29% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Medicare PPO Blue PlusRx?
To qualify for enrollment in Medicare PPO Blue PlusRx, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Medicare PPO Blue PlusRx and enjoy the extensive healthcare benefits it offers.
When Should You Enroll in Medicare PPO Blue PlusRx?
To ensure you don’t miss your chance to enroll in Medicare PPO Blue PlusRx, be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
Steps to Enroll in Medicare PPO Blue PlusRx
Enrolling in Medicare PPO Blue PlusRx is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Medicare PPO Blue PlusRx through the official Medicare website.
- Directly with Medicare PPO Blue PlusRx: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H2230-002-0:
What’s the monthly premium for Medicare PPO Blue PlusRx (PPO)?
The 2026 premium is $300.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $4200.00, protecting you from larger bills once you hit that limit.
What’s the prescription-drug deductible for 2026?
The 2026 drug deductible is $200.00.
How is this plan rated by Medicare?
CMS rates it ★4.5 out of 5 stars for 2026.
Is Medicare PPO Blue PlusRx popular?
Enrollment stands at roughly 3,995 members.
Contact Blue Cross Blue Shield of Massachusetts
| Contact Type | Details |
|---|---|
| Website: | Blue Cross Blue Shield of Massachusetts Plan Page |
| New Members: | 1-800-678-2265 |
| Existing Members: | 1-800-200-4255 |
| Plan Address: | P.O. Box 55011 | Boston, MA 02205 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Blue Cross Blue Shield of Massachusetts, http://www.bluecrossma.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
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Page content managed by David Bynon, Medicare Analyst.
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