A non-government entity
Blue Shield 65 Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Shield 65 Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Shield 65 Plus (HMO) in 2025, please refer to our full plan details page.
Blue Shield 65 Plus (HMO) is a HMO plan offered by California Physicians' Service available for enrollment in 2025 to people living in San Bernardino County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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.
For Blue Shield 65 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Blue Shield 65 Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Blue Shield 65 Plus (HMO) plan has an enhanced alternative drug benefit, with a $0 deductible. During the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred pharmacies, and standard generic drugs have a $40 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The Blue Shield 65 Plus (HMO) plan offers a wide array of benefits including coverage for inpatient and outpatient services, with varying copays. Emergency services have a $140 copay, while primary care services have a $30 copay for mental health and psychiatric services. Preventive services, routine hearing exams, and home health services are available with no cost-sharing. Vision and dental services are included, with routine eye exams at no cost, and coverage for eyewear and a range of dental procedures with varied copays. Ambulance services have a $250 copay for ground transport and 20% coinsurance for air transport. The plan also covers home infusion, dialysis, and medical equipment, with some services requiring prior authorization and referrals.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Inpatient Hospital Psychiatric has a copay of $900 per admission or stay, while Additional Days for Inpatient Hospital-Acute is unlimited. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. For outpatient hospital services, there is a $150 copay. Outpatient substance abuse services have a copay of $30 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Shield 65 Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $5 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services are partially covered, while Routine Chiropractic Care and Podiatry Services are not covered. Individual and Group Sessions for Mental Health and Psychiatric Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance.
Preventive Services See details
The Blue Shield 65 Plus (HMO) plan covers preventive services including annual physical exams, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, with no cost-sharing. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing Services are covered under the Blue Shield 65 Plus (HMO) plan, including routine hearing exams with no copay, but fitting/evaluation for hearing aids and prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
The Blue Shield 65 Plus (HMO) plan covers vision services, including routine eye exams with no deductible, but only one exam is covered per year. Eyewear is covered, with a copay for contact lenses and eyeglass lenses and frames; contact lenses have a $20 copay and a maximum benefit of $190 per year, and both eyeglass lenses and frames have a $20 copay. Eyeglass lenses are limited to 1 pair per year, and eyeglass frames are limited to one frame every two years, with a maximum benefit of $190. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Shield 65 Plus (HMO) plan covers a range of dental services, including oral exams with a copay of $0-$16, dental x-rays with a copay of $0-$10, other diagnostic services with a copay of $0-$15, fluoride treatments with a $5 copay, and other preventive services with a copay of $0-$80. Restorative services have a copay of $19-$430, endodontics has a copay of $25-$373, periodontics has a copay of $40-$60, removable prosthodontics has a copay of $28-$525, oral and maxillofacial surgery has a copay of $23-$80, and fixed prosthodontics has a copay of $40-$430. Maxillofacial prosthetics and orthodontics are not covered, and implant services are offered as an optional, supplemental benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Shield 65 Plus (HMO) plan, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Shield 65 Plus (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered medical supplies. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $15.00. Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Blue Shield 65 Plus (HMO) plan with no copay and no coinsurance, but authorization and referral are required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Shield 65 Plus (HMO) plan with prior authorization and a doctor referral required. There is no copay for days 1-20, and a $100 copay for days 21-100; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered by the Blue Shield 65 Plus (HMO) plan. Specifically, acupuncture, over-the-counter items, meal benefits, and other listed services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved