Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H1666-805

Medicare Plan

Blue Cross Group Medicare Advantage Plan (PPO) · Blue Cross and Blue Shield of NM, TX · Local PPO · Nationwide

Full CMS plan ID: H1666-805-000

H1666-805-000 is the full CMS identifier for the H1666-805 Medicare plan. Common searches include H1666 805 and H1666805.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Blue Cross Group Medicare Advantage Plan (PPO)

H1666-805-000 Nationwide Local PPO Employer-only

At-a-glance

Quick view

01

In-network

Inpatient hospital

inpatient coinsurance is selected but its percentage is missing

02

Emergency transport

Ambulance

Ground · in-network20% coinsurance
Air · in-network20% coinsurance
03

Emergency services

Emergency room

20% coinsurance

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + out$13,900
05

Skilled care at home

Home health

In-network0% coinsurance
Out-of-network0% coinsurance
06

Monthly cost

Premium & giveback

Part C premiumNot reported
Consolidated C + DNot reported

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-network20% coinsurance
Out-of-network20% coinsurance

Specialist

In-network20% coinsurance
Out-of-network20% coinsurance

Preventive care

In-network20% coinsurance
Out-of-network0% coinsurance
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network20% coinsurance
Out-of-network20% coinsurance

Laboratory services

In-network0% coinsurance
Out-of-network20% coinsurance

X-rays & standard imaging

In-network20% coinsurance
Out-of-network20% coinsurance

MRI, CT & PET imaging

In-network20% coinsurance
Out-of-network20% coinsurance
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network20% coinsurance
Out-of-networkNot separately reported

Ground ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Air ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Outpatient hospital

In-network20% coinsurance
Out-of-network20% coinsurance

Outpatient surgery / ASC

In-network20% coinsurance
Out-of-network20% coinsurance
Recovery & therapy5 benefits

Home health

In-network0% coinsurance
Out-of-network0% coinsurance

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network20% coinsurance
Out-of-network20% coinsurance

Occupational therapy

In-network20% coinsurance
Out-of-network20% coinsurance

Physical & speech therapy

In-network20% coinsurance
Out-of-network20% coinsurance
Behavioral health2 benefits

Mental health services

In-network20% coinsurance
Out-of-network20% coinsurance

Substance use treatment

In-network20% coinsurance
Out-of-network20% coinsurance
Specialty care2 benefits

Podiatry

In-network20% coinsurance
Out-of-network20% coinsurance

Chiropractic

In-network20% coinsurance
Out-of-network20% coinsurance
Supplemental benefits7 benefits

Dental

In-network20% coinsurance
Out-of-network20% coinsurance

Vision

In-network20% coinsurance
Out-of-network20% coinsurance

Hearing

In-network20% coinsurance
Out-of-network20% coinsurance

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

Not reported in this CMS export

Not reported in this CMS export

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

Not reported in this CMS export

Not reported in this CMS export

Plan costs & rulesCoverage overview

Premium & Part B giveback

Part C premium not reported · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$9,250
Combined in + out$13,900

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs0 tiers

Part D deductible

This plan is not present in the public CMS Landscape release

Using this plan

Understand H1666-805-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Blue Cross Group Medicare Advantage Plan (PPO) is a 2026 Local PPO offered by Blue Cross and Blue Shield of NM, TX in Nationwide. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
20% coinsurance
Specialist
20% coinsurance
Laboratory services
0% coinsurance

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
20% coinsurance
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
20% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
20% coinsurance

Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Nationwide (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY)
Plan type
Local PPO
Contract / plan
H1666-805
Coverage year
2026

Enrollment is limited to people eligible through the sponsoring employer or group. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental20% coinsurance
Vision20% coinsurance
Hearing20% coinsurance

Plan-specific answers

Frequently asked questions

Where is H1666-805-000 available?

Blue Cross Group Medicare Advantage Plan (PPO) is listed for Nationwide (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY). Enrollment is limited to people eligible through the sponsoring employer or group.

What is the in-network maximum out-of-pocket limit for H1666-805-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.

What does an emergency room visit cost on H1666-805-000?

The plan record lists 20% coinsurance, waived when an admission meets the plan's stated timing rule.

Does H1666-805-000 report extra benefits?

Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H1666-805-000 fits

Full CMS plan ID
H1666-805-000
Contract
H1666
Base plan code
H1666-805
Segment
000
Carrier
Blue Cross and Blue Shield of NM, TX
Plan type
Local PPO
Service area
Nationwide (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, GU, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VI, VT, WA, WI, WV, WY)

45 additional service-area states listed in the CMS record.

County/service-area foundation

CMS service-area entries

These named entries come from a CMS contract-level service-area file. They describe the contract's published geography and must not be treated as proof that every segment has identical county-level rules.

  • Aleutians East, AK · employer/group only
  • Aleutians West, AK · employer/group only
  • Anchorage, AK · employer/group only
  • Bethel, AK · employer/group only
  • Bristol Bay, AK · employer/group only
  • Chugach, AK · employer/group only
  • Copper River, AK · employer/group only
  • Denali, AK · employer/group only
  • Dillingham, AK · employer/group only
  • Fairbanks North Star, AK · employer/group only
  • Haines, AK · employer/group only
  • Hoonah-Angoon, AK · employer/group only

3316 additional service-area entries are retained in the data record.

Same CMS contract

H1666-003-000 Blue Cross Medicare Advantage Choice Premier (PPO) Dallas/Austin/Houston Mid PPO · Local PPO H1666-006-000 Blue Cross Medicare Advantage Choice Plus (PPO) Dallas/Austin/Houston $0 Low PPO · Local PPO H1666-008-000 Blue Cross Medicare Advantage Choice Plus (PPO) Mid South Texas $0 Low PPO · Local PPO H1666-012-000 Blue Cross Medicare Advantage Choice Premier (PPO) NM Defined PPO · Local PPO H1666-014-000 Blue Cross Medicare Advantage Health Choice (PPO) NM Flex Card PPO · Local PPO H1666-016-000 Blue Cross Medicare Advantage Dental Premier (PPO) NM Enhanced Dental PPO · Local PPO H1666-019-000 Blue Cross Medicare Advantage Balance (PPO) NM $Mid PPO · Local PPO H1666-020-000 Blue Cross Medicare Advantage Optimum (PPO) NM $High PPO · Local PPO

About this code

What H1666-805-000 identifies

H1666-805-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H1666-805, H1666 805, or the compact full CMS ID H1666805000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.