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Blue Shield 65 Plus Plan 2 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Shield 65 Plus Plan 2 (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 Plan 2 (HMO) in 2025, please refer to our full plan details page.
Blue Shield 65 Plus Plan 2 (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 3.5 out of 5 stars in 2025.
It's important to know that Blue Shield 65 Plus Plan 2 (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 Plan 2 (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 Plan 2 (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 $2100.00 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:
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Drug Coverage
The Blue Shield 65 Plus Plan 2 (HMO) has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $10 at a preferred pharmacy and $18 at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Blue Shield 65 Plus Plan 2 (HMO) offers a range of benefits with varying cost-sharing. Inpatient hospital stays have either no coinsurance or a $900 copay depending on the service, and outpatient services have copays ranging from $30 to $150. Emergency services have a $140 copay, while primary care and specialist visits have copays between $0 and $30. Preventive services, hearing exams, and many physical therapy services have no copay. Dental services, vision services, and ambulance services are covered with copays and coinsurance depending on the service. The plan also covers home health services with no copay, and skilled nursing facilities with a copay that varies based on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with no coinsurance and additional days covered, and Inpatient Hospital Psychiatric with a $900 copay per admission or stay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a $150 copay for Outpatient Hospital Services and $30 copays for both individual and group outpatient substance abuse sessions; observation services, ambulatory surgical center services, and outpatient blood services are also covered. Outpatient blood services also includes an enhanced benefit with a three (3) pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Shield 65 Plus Plan 2 (HMO), with a $40 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Shield 65 Plus Plan 2 (HMO), 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 a plan-approved health-related location are covered for up to 14 one-way trips per year, using rideshare services, bus/subway, medical transport, or other transportation methods; however, transportation services to any other 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 Plan 2 (HMO), with a $140 copay for Emergency and Worldwide Emergency Coverage, and a $10 copay for Urgently Needed Services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Shield 65 Plus Plan 2 (HMO) covers primary care physician services, chiropractic services with a $5 copay, occupational therapy, physician specialist services with a $0-$5 copay, mental health specialty services with a $30 copay for individual and group sessions, podiatry services with a $5 copay, other health care professional services with a $0-$5 copay, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care is not covered.
Preventive Services See details
The Blue Shield 65 Plus Plan 2 (HMO) covers preventive services, including annual physical exams, with no copay. The plan also covers Fitness Benefit, Remote Access Technologies, and Kidney Disease Education Services. However, health education, in-home safety assessments, and many other services are not covered.
Hearing Services See details
Hearing exams are covered under the Blue Shield 65 Plus Plan 2 (HMO), including routine hearing exams, with no deductible. However, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $5 copay, and one routine eye exam per year. Contact lenses are covered with a $20 copay and a maximum plan benefit coverage amount of $170 every year, while eyeglass lenses and eyeglass frames are covered with a $20 copay. Eyeglass frames are limited to one frame every two years with a maximum plan benefit of $170. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Shield 65 Plus Plan 2 (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, and fluoride treatments with a $5 copay. Prosthodontics, fixed has a copay of $40-$430, and oral and maxillofacial surgery has a copay of $23-$80, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, Prosthetics/Medical Supplies (non-Medicare benefit) with coinsurance and no copay, and Diabetic Equipment, though some services are not covered. Durable Medical Equipment for use outside the home, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Shield 65 Plus Plan 2 (HMO), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services are covered with at most 20% coinsurance, and no copay for any services.
Home Health Services See details
Home Health Services are covered by the Blue Shield 65 Plus Plan 2 (HMO) with no copay and no coinsurance. Additional hours of care and personal care services are not covered, and authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not specify the cost sharing for these services. The following services are not covered: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Shield 65 Plus Plan 2 (HMO) with a doctor referral and prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management (long term care), institution for mental disease services for individuals 65 or older, services in an intermediate care facility for individuals with intellectual disabilities, case management, tobacco cessation counseling for pregnant women, freestanding birth center services, respiratory care services, family planning services, nursing home services, home and community based services, personal care services, and self-directed personal assistance services. No authorization or referral is required for these services.
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