Blue Medicare Advantage Enhanced PPO (PPO) 2026 Plan Details for Aurora County, South Dakota Residents
Blue Medicare Advantage Enhanced PPO (PPO) 2026 Plan Details for Aurora County, South Dakota Residents
Choosing the right Medicare Advantage plan in Aurora County is crucial for your healthcare needs in 2026. With Blue Medicare Advantage Enhanced PPO (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 8,347 members enrolled in this plan, 45 in Aurora County.
Blue Medicare Advantage Enhanced PPO Overview
| Plan ID H5900-004-0 Overview | |
|---|---|
| Health Plan ID: | H5900-004-0 |
| Medicare Advantage Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $80.00 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, $300.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Aurora County, SD |
| Insured By: | Wellmark Advantage Health Plan |
Explore the Benefits of Blue Medicare Advantage Enhanced PPO
This MAPD PPO Medicare Advantage plan offers broad coverage with the freedom to choose your providers. With a monthly premium of $80.00, it includes all core benefits under Medicare Part A and Part B, plus prescription drug coverage to manage ongoing medications. The annual Part D deductible is $300.00. You can see any Medicare-approved provider — in or out of network — though in-network care typically costs less.
Primary care visits have a $0 copay | Out-of-network: $10 copay, and specialist visits come with a $30 copay | Out-of-network: $40 copay. Urgent care services carry a $45 copay, and ground ambulance transportation is $325 copay | Out-of-network: $325 copay. These costs all count toward your annual maximum out-of-pocket (MOOP) limit of $4200.00. After that limit is reached, all in-network care is fully covered through the end of the year.
CMS recognizes this plan as H5900-004-0. A detailed breakdown of cost sharing is available below. Still have questions? Check the FAQ section for more insights.
| We're Here to Help You Enroll |
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Out-of-Pocket Costs
With Blue Medicare Advantage Enhanced PPO, you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H5900-004-0.
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: $10 copay |
| Specialist: | In-network: $30 copay | Out-of-network: $40 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-$45 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| 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: | $120 copay |
| Wordwide emergency care: | $120 copay |
| Urgent care: | $45 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $460 per stay | Out-of-network: | $600 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $200 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $230 per day for days 21-100 | $0 per stay |
| Ground ambulance: | In-network: $325 copay | Out-of-network: $325 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: $30 copay | Out-of-network: $40 copay |
| Outpatient group therapy: | In-network: $30 copay | Out-of-network: $40 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $460 per stay | Out-of-network: | $600 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: $40 copay |
| Occupational therapy: | In-network: $20 copay | Out-of-network: $40 copay |
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: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 30% 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: $125 copay | Out-of-network: $175 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $5 copay |
| Outpatient x-rays: | In-network: $10 copay | Out-of-network: $20 copay |
| Diagnostic tests and procedures: | In-network: $30 copay | Out-of-network: $40 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 30% 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: $0 copay, 0% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Periodontics: | In-network: 0%-50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Endodontics: | In-network: 50% coinsurance | Out-of-network: 50% coinsurance |
| Restorative services: | In-network: 25%-50% coinsurance | Out-of-network: 25%-50% coinsurance |
| Implant services: | In-network: 50% coinsurance | Out-of-network: 50% coinsurance |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 0%-50% coinsurance | Out-of-network: 0%-50% coinsurance |
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: $0 copay, 0% coinsurance |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | Not covered |
| 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: 50% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Upgrades: | In-network: $0 copay | Out-of-network: 50% coinsurance |
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: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Blue Medicare Advantage Enhanced PPO as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Blue Medicare Advantage Enhanced PPO 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: | $17.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $17.00 |
| Low-Income Premium Subsidy: | $41.47 |
| Low-Income Premium Subsidy Paid by CMS: | $17.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $300.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Wellmark Advantage Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Blue Medicare Advantage Enhanced PPO 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 | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | 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) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| 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 Blue Medicare Advantage Enhanced PPO?
To qualify for enrollment in Blue Medicare Advantage Enhanced PPO, 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 Blue Medicare Advantage Enhanced PPO and enjoy the extensive healthcare benefits it offers.
Enrollment Periods for Blue Medicare Advantage Enhanced PPO
Understanding the right time to enroll in Blue Medicare Advantage Enhanced PPO is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a 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 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in Blue Medicare Advantage Enhanced PPO
Getting started with Blue Medicare Advantage Enhanced PPO is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Blue Medicare Advantage Enhanced PPO. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID H5900-004-0:
What’s the monthly premium for Blue Medicare Advantage Enhanced PPO (PPO)?
For 2026, the monthly premium is $80.00, and you still pay your Part B premium to Medicare.
What’s the MOOP for Blue Medicare Advantage Enhanced PPO in 2026?
Your costs top out at $4200.00 (for in-network services) in 2026; after that the plan pays 100% of covered services.
How much do I pay before drug coverage starts?
Yes. The Part D deductible is $300.00.
Is this a 4-star or 5-star plan?
The latest CMS score is ★3.5 out of 5 stars; anything 4 or higher earns quality bonuses.
How many people are enrolled in this plan?
Enrollment stands at roughly 8,347 members.
Contact Wellmark Advantage Health Plan
| Contact Type | Details |
|---|---|
| Website: | Wellmark Advantage Health Plan Plan Page |
| New Members: | 1-800-213-3771 |
| Existing Members: | 1-855-716-2544 |
| Plan Address: | P.O. Box 211501 | Eagan, MN 55121 |
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.
- Wellmark Advantage Health Plan, http://www.Wellmarkadvantagehealthplan.com — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — 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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