Capital Blue Cross Prime (PPO) in Franklin County, Pennsylvania — 2026 plan details
Last updated Jul 18, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Capital Blue Cross Prime (PPO) (H3923-017) is a $177-premium Medicare Advantage PPO from CAPITAL BLUE CROSS available in Franklin County, Pennsylvania in 2026, with a 4.5-star overall rating, a $6,700 in-network out-of-pocket maximum, and a $100 annual Part D drug deductible.
Plan facts (CMS CY2026 Landscape file)
| Organization | CAPITAL BLUE CROSS |
|---|---|
| Plan name | Capital Blue Cross Prime (PPO) |
| Contract ID | H3923 |
| Plan ID | 017 |
| Segment ID | 0 |
| Contract year | 2026 |
| Contract category | MA-PD |
| Plan type | PPO |
| SNP | No |
| Monthly consolidated premium | $177.00 |
| Part C premium | $99.70 |
| Part D basic premium | $77.30 |
| Part D total premium | $77.30 |
| Annual Part D deductible | $100.00 |
| Maximum out-of-pocket (in-network) | $6700.00 |
| Overall star rating | 4.5 |
How this plan is structured
- $177 consolidated premium. A $0 or near-$0 consolidated premium does not remove the Part B premium — the standard 2026 Part B premium is $202.90 per month and still applies. See the 2026 Medicare Part B premium.
- PPO plan type. Plan-type rules determine in-network use and referrals. See how Medicare Advantage HMO and PPO plans differ.
- $6,700 in-network out-of-pocket maximum. The MOOP is the annual cap on what a member pays in-network for covered Part A and Part B services. See how the Medicare Advantage MOOP works.
- Service area = Franklin County. Medicare Advantage plans are sold by service area; moving out of the plan's service area triggers a Special Enrollment Period to switch plans. See how moving changes your Medicare options.
How it compares in Franklin County
The CMS CY2026 Landscape file lists 82 Medicare Advantage plans in Franklin County, Pennsylvania, of which 0 carry a 5.0-star overall rating and 35 have a $0 consolidated monthly premium. Consolidated premiums range from $0.00 to $226.00 per month, and in-network out-of-pocket maximums range from $1500.00 to $9250.00.
For the full county plan directory, see all Medicare plans in Franklin County, Pennsylvania.
How to verify your doctors take this plan
Network participation changes throughout the year; we hold no provider-network data, so verify directly with these three sources before you decide:
- Open the plan's official Medicare.gov page and use its provider-directory link: Medicare.gov Plan Finder — H3923-017.
- Call the plan (CAPITAL BLUE CROSS) using the member-services number listed on that plan page and ask whether each doctor, hospital, and pharmacy is in-network for 2026.
- Get free, unbiased help from your State Health Insurance Assistance Program (SHIP) — see free unbiased Medicare help from SHIP.
What H3923-017 means
CMS assigns every Medicare Advantage and Part D offering a plan identifier made of three parts. In H3923-017, the leading H marks the contract type (H = Medicare Advantage / Part C contract), the four digits 3923 are the contract number issued to the organization, and the three-digit 017 is the plan benefit package under that contract. The segment ID 0 identifies the service-area segment within the plan (0 = the default single segment).
Frequently asked questions
Is Capital Blue Cross Prime (PPO) an HMO or PPO?
Capital Blue Cross Prime (PPO) is a PPO Medicare Advantage plan.
Does Capital Blue Cross Prime (PPO) include prescription drug coverage?
Yes — Capital Blue Cross Prime (PPO) is a Medicare Advantage plan with prescription drug coverage (MA-PD) and a $100.00 annual Part D drug deductible for 2026.
What is the maximum out-of-pocket cost for Capital Blue Cross Prime (PPO)?
The 2026 in-network maximum out-of-pocket limit for Capital Blue Cross Prime (PPO) is $6700.00, per the CMS CY2026 Landscape file.
What counties offer Capital Blue Cross Prime (PPO) (H3923-017)?
Capital Blue Cross Prime (PPO) (H3923-017) is offered in 21 Pennsylvania counties: Adams County, Berks County, Centre County, Columbia County, Cumberland County, Dauphin County, Franklin County, Fulton County, Juniata County, Lancaster County, Lebanon County, Lehigh County, Mifflin County, Montour County, Northampton County, Northumberland County, Perry County, Schuylkill County, Snyder County, Union County, and York County.
Sources
- CMS, Plan Year 2026 Medicare Advantage & Part D Landscape source file (March 2026) — retrieved 2026-07-18. Overall star rating year: 2026.
- Medicare.gov Plan Finder — compare plans and enroll.