2026 Medicare plan code

H0107-007-000

Blue Cross Medicare Advantage Dental Premier (PPO) · Blue Cross and Blue Shield of Montana · MT Enhanced Dental PPO

Compact plan code: H0107007000

2026

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

● CMS 2026 plan record

Blue Cross Medicare Advantage Dental Premier (PPO)

H0107-007-000 MT Enhanced Dental PPO Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–6 $400 / day
Days 7–90 $0 / day
Total of listed copays · 6 charged days $2,400
02

Emergency transport

Ambulance

Ground · in-network$350 copay
Air · in-network20% coinsurance
03

Emergency services

Emergency room

$100 copay

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$8,100
Combined in + out$13,900
05

Skilled care at home

Home health

In-network$0 copay
Out-of-network50% coinsurance
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

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. Quick-reference values should be confirmed in current official plan documents.

About this code

What H0107-007-000 identifies

H0107-007-000 is a Contract Year 2026 Medicare plan segment code. The compact form H0107007000 refers to the same normalized contract, plan, and segment shown on this page.

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.