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Blue Shield 65 Plus Choice Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Shield 65 Plus Choice Plan (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 Choice Plan (HMO) in 2025, please refer to our full plan details page.
Blue Shield 65 Plus Choice Plan (HMO) is a HMO plan offered by California Physicians' Service available for enrollment in 2025 to people living in Riverside and San Bernardino 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 Choice Plan (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 Choice Plan (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 Choice Plan (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 $800.00 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 Choice Plan (HMO) has no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions. For preferred generic drugs, the copay is $3.00 at a preferred pharmacy and $10.00 at a standard pharmacy. For standard generic drugs, the copay is $35.00 at a preferred pharmacy and $47.00 at a standard pharmacy. For preferred brand drugs, the copay is $95.00 at a preferred pharmacy and $100.00 at a standard pharmacy. For non-preferred drugs, you pay 33% coinsurance.
Additional Benefits
The Blue Shield 65 Plus Choice Plan (HMO) offers a range of benefits, including coverage for inpatient and outpatient services, and primary care with a $30 copay for mental health and psychiatric services. Emergency services have a $140 copay, and ambulance services have a $250 copay for ground transport and 20% coinsurance for air transport. The plan also includes dental, vision, and hearing benefits. This plan provides additional benefits like home infusion, dialysis, and medical equipment, with varying copays and coinsurance. It also covers home health services with no copay, and offers an over-the-counter (OTC) allowance of $80 every three months. However, some services like additional hours of care, and several rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits with the Blue Shield 65 Plus Choice Plan (HMO) include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, which both require prior authorization and a doctor referral. Inpatient Hospital Psychiatric has a copay of $900 per admission or stay for Medicare-covered stays, while additional days for Inpatient Hospital Psychiatric, and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a $150 copay, while individual and group sessions for outpatient substance abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Shield 65 Plus Choice Plan (HMO), with a $40 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Shield 65 Plus Choice Plan (HMO). 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. 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 under the Blue Shield 65 Plus Choice Plan (HMO), with a $140 copay and no coinsurance for emergency services and worldwide emergency coverage. Worldwide Urgent Coverage also has a $140 copay and no coinsurance, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Shield 65 Plus Choice Plan (HMO) covers Primary Care, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Individual and group sessions for mental health and psychiatric specialty services have a $30 copay. Routine Chiropractic Care is covered for 12 visits per year.
Preventive Services See details
Preventive services are covered under the Blue Shield 65 Plus Choice Plan (HMO), including services not usually covered by Medicare plans. Some additional preventive services are not covered, including Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, with a limit of one routine hearing exam per year when performed by the network hearing aid vendor and two fitting/evaluation visits per year. Prescription hearing aids are covered with a copay between $449 and $699 for all types, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
The Blue Shield 65 Plus Choice Plan (HMO) covers vision services, including routine eye exams with no copay and eyewear benefits. This plan covers contact lenses, eyeglass lenses, and eyeglass frames, however, eyeglasses and upgrades are not covered.
Dental Services See details
The Blue Shield 65 Plus Choice Plan (HMO) 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 other diagnostic dental services with a copay of $0-$15. The plan also covers fluoride treatments with a $5 copay, other preventive dental services with a copay of $0-$80, restorative services with a copay of $19-$430, adjunctive general services with a copay of $0-$80, endodontics with a copay of $25-$373, periodontics with a copay of $40-$60, prosthodontics (removable) with a copay of $28-$525, prosthodontics (fixed) with a copay of $40-$430, and oral and maxillofacial surgery with a copay of $23-$80. 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Blue Shield 65 Plus Choice Plan (HMO), but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and no copay, and Prosthetic Devices with a 20% coinsurance and no copay. 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 partially covered under the Blue Shield 65 Plus Choice Plan (HMO). Diagnostic procedures/tests, lab services, diagnostic radiological services, and outpatient X-ray services are not covered, but therapeutic radiological services are covered with a coinsurance of at most 20%, and no copay.
Home Health Services See details
Home Health Services are covered by the Blue Shield 65 Plus Choice Plan (HMO) with no copay and no coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Shield 65 Plus Choice Plan (HMO) with prior authorization and a doctor referral required. You will have no copay for days 1-20, and a $75 copay for days 21-100; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Blue Shield 65 Plus Choice Plan (HMO) other services benefit includes over-the-counter (OTC) items with a maximum benefit of $80 every three months, and a meal benefit for chronic illness, but does not cover acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, or many other services.
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