Blue Shield 65 Plus (HMO)

Blue Shield 65 Plus (HMO) is a HMO plan offered by California Physicians' Service available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Blue Shield 65 Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Blue Shield 65 Plus (HMO).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Blue Shield 65 Plus (HMO) plan features an Enhanced Alternative drug benefit with a $340.00 annual prescription drug deductible. Once this deductible is met, you will pay a $5.00 copay for Tier 1 preferred generic drugs at preferred pharmacies or a $12.00 copay at standard pharmacies. Other tiers require coinsurance, including 20% for standard generics and 25% for preferred brands, during the initial coverage phase up to $2,100.00 in total drug costs. Individuals who qualify for the full Low-Income Subsidy will have no premium for Part D. After reaching $2,100.00 in yearly out-of-pocket drug costs, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.

Additional Benefits

The Blue Shield 65 Plus (HMO) plan offers comprehensive coverage for essential medical needs, including Medicare-approved preventive services and annual physical exams with no copays or coinsurance. Outpatient hospital visits and emergency services are available with a $150 copay and no coinsurance, while urgently needed care requires no copay. For inpatient psychiatric hospital stays, members pay a $900 copay per admission, and skilled nursing facility stays feature no copay for the first 20 days. Specialty benefits include dental care with copays ranging from no copay up to $525, alongside vision and hearing coverage that features annual exams with no deductible. Prescription hearing aids require a copay between $449 and $999, while durable medical equipment and dialysis services generally require up to 20% coinsurance. Please note that some services, such as routine transportation, cardiac rehabilitation, and diabetic supplies, are not covered under this plan.