Medicare Advantage Plan H8634-025-0 in Martin County, TX Blue Cross Medicare Advantage Health Choice (PPO) • 2026
Plan-ID H8634-025-0 refers to Blue Cross Medicare Advantage Health Choice (PPO), a Medicare Advantage Plan (Part C) offered by Blue Cross and Blue Shield of IL, NM, OK, TX for the 2026 plan year. This plan is a Preferred Provider Organization (PPO) model with Part D prescription drug coverage.
According to CMS enrollment data, an estimated 152 beneficiaries are enrolled in this plan, 0 enrollees reside in Martin County.
Blue Cross Medicare Advantage Health Choice Overview
Plan Overview for H8634-025-0 |
|
|---|---|
| CMS Plan ID: |
H8634-025-0
|
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $750 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Martin County, TX |
| Enrollment (Nationwide): | 152 beneficiaries |
| Enrollment (CMS – Local) | 0 beneficiaries in Martin County |
| Provided By: | Blue Cross and Blue Shield of IL, NM, OK, TX |
To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).
Medicare Plan Decision Resources
Frequently Asked Questions About Blue Cross Medicare Advantage Health Choice (PPO)
Here are some of the most frequently asked questions people have about Plan ID H8634-025-0:
What is the 2026 premium for Plan ID H8634-025-0?
Plan ID H8634-025-0 has a monthly premium of $0.00 for 2026, in addition to any Medicare Part B premium you must pay.
What is the out-of-pocket maximum for Plan ID H8634-025-0?
Plan ID H8634-025-0 has a 2026 in-network maximum out-of-pocket (MOOP) limit of $9250.00. After you reach this limit, the plan pays covered in-network Part A and Part B costs for the remainder of the year.
Does Blue Cross Medicare Advantage Health Choice include Medicare Part D prescription drug coverage?
Yes. Blue Cross Medicare Advantage Health Choice includes Medicare Part D prescription drug coverage. The 2026 Part D deductible is $615.00.
How is Plan ID H8634-025-0 rated by CMS?
Plan ID H8634-025-0 is included under contract H8634, which has a ★3.0 out of 5 CMS Star Rating for 2026.
What type of provider network does Blue Cross Medicare Advantage Health Choice use?
Blue Cross Medicare Advantage Health Choice uses a Preferred Provider Organization (PPO) provider network.
What is the enrollment for Plan ID H8634-025-0?
The most recent CMS enrollment data shows approximately 152 beneficiaries enrolled in Plan ID H8634-025-0.
Who provides Blue Cross Medicare Advantage Health Choice (PPO)?
Blue Cross and Blue Shield of IL, NM, OK, TX provides Blue Cross Medicare Advantage Health Choice (PPO).
CMS Medicare Star Ratings
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage PPOs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this Blue Cross and Blue Shield of IL, NM, OK, TX plan.
| 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 |
Covered Services & Costs
Office Visits
This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Specialist: | In-network: $46 copay | Out-of-network: 50% coinsurance |
Preventive and Wellness Services
Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
Diagnostic, Lab, and Imaging Services
Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0-$300 copay | Out-of-network: 50% coinsurance |
| Lab services: | In-network: $0-$50 copay | Out-of-network: 50% coinsurance |
| Outpatient x-rays: | In-network: $0-$100 copay | Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$100 copay | Out-of-network: 50% coinsurance |
Emergency and Urgent Care Services
Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $110 copay |
| Worldwide emergency care: | $110 copay |
| Urgent care: | $40 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $405 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | 50% per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-59 | $0 per day for days 60-100 | Out-of-network: | 50% per stay |
| Ground ambulance: | In-network: $275 copay | Out-of-network: $275 copay |
Mental Health Services
Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
| Outpatient group therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $405 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | 50% per stay |
Rehabilitation Services
Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $40 copay | Out-of-network: 50% coinsurance |
| Occupational therapy: | In-network: $35 copay | Out-of-network: 50% coinsurance |
Medical Equipment and Supplies
Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
Medicare Part B Drugs
Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
Dental Services
Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
Vision Services
Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
Hearing Services
Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay |
| Prescription hearing aids: | In-network: $699-$999 copay | Out-of-network: $699-$999 copay |
| OTC hearing aids: | Not covered |
Additional and Special Needs Services
Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Blue Cross Medicare Advantage Health Choice covers 100% of certain preventive services as a required Part B benefit.
Prescription Drug Coverage
Part D Coverage Level (Benefit Design)
Blue Cross Medicare Advantage Health Choice includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $4.82 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Plan Deductible
The Medicare Part D annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Blue Cross and Blue Shield of IL, NM, OK, TX begins paying its share.
Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Blue Cross Medicare Advantage Health Choice has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $1.00 copay | Coming soon |
| Preferred Brand | 18% coinsurance | Coming soon |
| Non-Preferred Drug | 39% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Contact Blue Cross and Blue Shield of IL, NM, OK, TX
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online .
| Contact Type | Details |
|---|---|
| Website: | Blue Cross and Blue Shield of IL, NM, OK, TX Plan Page |
| New Members: | 1-877-583-8129 |
| Existing Members: | 1-877-774-8592 |
| Plan Address: | PO Box 4555 | Scranton, PA 18505 |
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | 202608 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-08 |
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Cross and Blue Shield of IL, NM, OK, TX (official source) | http://getblueil.com/mapd | October 13, 2025 |
| Medicare.gov | Understanding 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 |
Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.
Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.
Medicare plan data and editorial content curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for Medicare plan interpretation and publication.