Capital Blue Cross Value (PPO) (2027)
Medicare Advantage plan with drug coverage from Capital Blue Cross, plan ID H3923-045-004. Sold in 4 counties in Pennsylvania.
2027 costs
With a Medicare Advantage plan you also keep paying your Medicare Part B premium.
What this plan would cost for your prescriptions
Add your prescriptions to see this plan's estimated yearly cost for them, which of them are on its drug list, and how each compares with Cost Plus Drugs prices.
See this plan with my prescriptionsWhat you pay for medical care
In-network amounts. A range means it depends on the service or provider.
Extra benefits
Drug costs by tier
| Tier | 30 days, standard pharmacy | 30 days, preferred pharmacy | 90 days by mail |
|---|---|---|---|
| 1 Preferred Generic | $10 | $0 | $0 |
| 2 Generic | $15 | $0 | $0 |
| 3 Preferred Brand | 19% | 19% | 19% |
| 4 Non-Preferred Drug | 20% | 20% | N/A |
| 5 Specialty Tier | 25% | 25% | N/A |
A percentage is coinsurance: your share of the drug's price. The drug deductible may apply first, depending on the tier. Your Part D out-of-pocket costs are capped at $2,400 for 2027.
Where it's sold
Pennsylvania (4 counties)
Plan costs and benefits are from CMS's 2027 Medicare plan data (data as of October 27, 2026). Star ratings are CMS's 2027 Star Ratings. Every year, Medicare evaluates plans based on a 5-star rating system. Benefits, premiums and copays can change from year to year; check the plan's Evidence of Coverage, call the plan, or use Medicare.gov before you enroll.