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

2026 Medicare plan code

H3923-017-000

Capital Blue Cross Prime (PPO) · Capital Blue Cross · Central Pennsylvania

Compact plan code: H3923017000

2026

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

● CMS 2026 plan record

Capital Blue Cross Prime (PPO)

H3923-017-000 Central Pennsylvania Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–6 $225 / day
Days 7–90 $0 / day
Total of listed copays · 6 charged days $1,350
02

Emergency transport

Ambulance

Ground · in-network$230 copay
Air · in-network$230 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$6,700
Combined in + out$6,700
05

Skilled care at home

Home health

In-network$0 copay
Out-of-network30% coinsurance
06

Monthly cost

Premium & giveback

Part C premium$99.70 / month
Consolidated C + D$177 / 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.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3923-013-000 Capital Blue Cross Classic (PPO) Central Pennsylvania · Local PPO H3923-044-001 Capital Blue Cross Select (PPO) Centre, Dauphin, Juniata, Mifflin, Perry · Local PPO H3923-044-002 Capital Blue Cross Select (PPO) Columbia, Montour, Northumberland, Snyder, Union · Local PPO H3923-044-003 Capital Blue Cross Select (PPO) Berks, Lehigh, Northampton, Schuylkill · Local PPO H3923-044-004 Capital Blue Cross Select (PPO) Cumberland, Fulton, Lancaster, Lebanon · Local PPO H3923-045-001 Capital Blue Cross Value (PPO) Centre, Dauphin, Juniata, Mifflin, Perry · Local PPO H3923-045-002 Capital Blue Cross Value (PPO) Columbia, Montour, Northumberland, Snyder, Union · Local PPO H3923-045-003 Capital Blue Cross Value (PPO) Berks, Lehigh, Northampton, Schuylkill · Local PPO

About this code

What H3923-017-000 identifies

H3923-017-000 is a Contract Year 2026 Medicare plan segment code. The compact form H3923017000 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.