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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 2026, 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 4 out of 5 stars in 2026.
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 a $340.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2200.00 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) prescription drug coverage features an annual deductible of $340. During the initial coverage phase, you will pay a $10 copay for preferred generics at preferred pharmacies, while standard pharmacies charge an $18 copay. Standard generics, preferred brands, and non-preferred drugs require coinsurance ranging from 20% to 29%. Individuals who qualify for the low-income subsidy will benefit from a premium reduction with no copay for Part D coverage. Once your yearly out-of-pocket costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. This structured plan helps beneficiaries easily anticipate their medication costs throughout the year.
Additional Benefits
The Blue Shield 65 Plus Plan 2 (HMO) offers comprehensive medical coverage with no copay or coinsurance for annual physicals and Medicare-covered preventive services. Emergency room and outpatient hospital visits require a $150 copay, while urgently needed care is available with no copay. Inpatient psychiatric stays require a $900 copay, and skilled nursing facility stays feature no copay for the first 20 days before a $100 daily copay applies. This plan also features key supplemental benefits, including routine eye exams with no copay and dental care with copays ranging from no copay up to $525. Eligible members can also utilize up to 14 one-way transportation trips per year to plan-approved locations at no cost. Please note that certain services, such as cardiac rehabilitation, acupuncture, and over-the-counter items, are not covered.
Inpatient Hospital See details
Blue Shield 65 Plus Plan 2 (HMO) partially covers inpatient hospital services, requiring prior authorization and a doctor referral for both acute and psychiatric stays. Psychiatric admissions require a $900 copay and no coinsurance, while acute care upgrades, additional psychiatric days, and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Blue Shield 65 Plus Plan 2 (HMO) covers outpatient services with no coinsurance, featuring a $150 copay for outpatient hospital services and a $30 copay for outpatient substance abuse sessions. Ambulatory surgical center, observation, and outpatient blood services are also covered with no deductible.
Partial Hospitalization See details
Blue Shield 65 Plus Plan 2 (HMO) covers partial hospitalization services with a $40 copay and no coinsurance. This benefit requires both a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Blue Shield 65 Plus Plan 2 (HMO), featuring a $250 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation services are partially covered, offering up to 14 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Blue Shield 65 Plus Plan 2 (HMO) covers emergency services with a $150 copay and urgently needed services with no copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are covered by Blue Shield 65 Plus Plan 2 (HMO) with no coinsurance, featuring a $30 copay for psychiatric and mental health sessions and a $10 copay for opioid treatment. Chiropractic services are only partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Blue Shield 65 Plus Plan 2 (HMO) covers Medicare-covered preventive services and annual physical exams with no copay or coinsurance, though certain services require a doctor's referral. Additional preventive benefits are partially covered, including memory fitness and remote access technologies, while services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Blue Shield 65 Plus Plan 2 (HMO) covers hearing services with no deductible, meaning some services are covered but routine hearing exams, hearing aid fittings and evaluations, prescription hearing aids, and OTC hearing aids are not covered. Covered exams require a doctor referral, though specific copay and coinsurance costs are not specified.
Vision Services See details
Blue Shield 65 Plus Plan 2 (HMO) partially covers vision services, excluding upgrades and combined eyeglasses (lenses and frames). Covered routine eye exams require no copay and no coinsurance, while covered eyeglass lenses, frames, and contact lenses require a doctor referral, a $20 copay, and no coinsurance.
Dental Services See details
Dental services are partially covered by the Blue Shield 65 Plus Plan 2 (HMO), featuring no coinsurance and copays ranging from no copay up to $525 depending on the procedure. While preventive, diagnostic, and restorative care are included, orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Blue Shield 65 Plus Plan 2 (HMO) partially covers home infusion bundled services requiring prior authorization, though Part D home infusion drugs as part of a bundled service are not covered. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Shield 65 Plus Plan 2 (HMO) covers dialysis services with 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Medical equipment is partially covered by Blue Shield 65 Plus Plan 2 (HMO), which offers durable medical equipment with no copay and coinsurance ranging from no coinsurance to 20%, and prosthetic devices with no copay and 20% coinsurance. Medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the Blue Shield 65 Plus Plan 2 (HMO) with no copays, though a doctor referral is required. While therapeutic radiological services are covered with a 20% coinsurance, diagnostic procedures and tests, lab services, diagnostic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home health services are covered under the Blue Shield 65 Plus Plan 2 (HMO), requiring prior authorization and a doctor referral for members to access care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Blue Shield 65 Plus Plan 2 (HMO) because none of the associated sub-services, including intensive cardiac, pulmonary, and SET for PAD services, are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Blue Shield 65 Plus Plan 2 (HMO), requiring prior authorization and a doctor referral. Stays feature no copay for days 1 through 20, a $100 daily copay for days 21 through 100, and no coinsurance, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the Blue Shield 65 Plus Plan 2 (HMO), meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, meal benefits, or dual eligible SNPs with highly integrated services.
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