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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 2026, 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 4 out of 5 stars in 2026.
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 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 $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) features an Enhanced Alternative drug benefit with a $340.00 prescription drug deductible. After meeting this deductible, you will pay a $3.00 copay for Tier 1 preferred generic drugs at preferred pharmacies, while standard pharmacies charge a $10.00 copay. Other tiers require coinsurance, including 20% for standard generics, 25% for preferred brands, and 29% for non-preferred drugs. These cost-sharing rates apply until your total yearly out-of-pocket drug costs reach $2,100.00, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy will receive a premium reduction, resulting in no copay for Part D.
Additional Benefits
The Blue Shield 65 Plus Choice Plan (HMO) provides comprehensive medical coverage designed to keep your out-of-pocket costs predictable. Members enjoy no copay for urgent care and routine preventive services, while emergency room visits carry a $150 copay. Additionally, outpatient hospital services require a $150 copay, and skilled nursing facility stays are covered with no copay for the first 20 days. This plan also features essential specialty benefits, including dental care with no coinsurance and routine hearing exams with no copay. You will also receive a $220 allowance for eyewear and a quarterly $80 allowance for over-the-counter health items with no copay. Prescription hearing aids are covered with copays ranging from $449 to $999, ensuring affordable access to key wellness resources.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by the Blue Shield 65 Plus Choice Plan (HMO), requiring a $900 copayment and no coinsurance per admission for psychiatric stays, and no cost sharing on the day of discharge for acute stays. Non-Medicare-covered stays, acute upgrades, and additional psychiatric days are not covered, and prior authorization and doctor referrals are required for inpatient care.
Outpatient Services See details
Outpatient services are covered under the Blue Shield 65 Plus Choice Plan (HMO), featuring a $150 copay for outpatient hospital services and a $30 copay for outpatient substance abuse sessions with no coinsurance. Covered ambulatory surgical center, observation, and outpatient blood services also require no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Blue Shield 65 Plus Choice Plan (HMO) with a $40.00 copay and no coinsurance. This benefit requires both a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Blue Shield 65 Plus Choice Plan (HMO) covers ambulance services with a $250 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are partially covered, offering up to 14 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Blue Shield 65 Plus Choice Plan (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within one day. Urgently needed services feature no copay or coinsurance, while worldwide emergency services are partially covered with a $150 copay and no coinsurance, as worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are covered by the Blue Shield 65 Plus Choice Plan (HMO), including physician visits, physical therapy, and podiatry with no coinsurance. While most services require a doctor referral, there is a $30 copay for mental health and psychiatric sessions, and a $15 copay for opioid treatment services.
Preventive Services See details
Preventive services are partially covered by the Blue Shield 65 Plus Choice Plan (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar preventive services and annual physical exams. Additional covered benefits include personal emergency response systems, memory fitness, and remote access technologies, though referrals are required for kidney disease education and other select screenings. Non-covered sub-services include health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, additional 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 are partially covered by the Blue Shield 65 Plus Choice Plan (HMO), which offers annual routine hearing exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids (all types) are covered with a copay of $449 to $999 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Blue Shield 65 Plus Choice Plan (HMO), which features no deductible for annual routine eye exams, yearly eyeglass lenses, eyeglass frames up to $220 every two years, and contact lenses up to $220 annually. Bundled eyeglasses (lenses and frames) and eyewear upgrades are not covered under this plan.
Dental Services See details
Blue Shield 65 Plus Choice Plan (HMO) offers partial coverage for dental services, with maxillofacial prosthetics and orthodontics not covered. Covered dental benefits require copays ranging from no copay up to $525, and there is no coinsurance.
Home Infusion bundled Services See details
Blue Shield 65 Plus Choice Plan (HMO) partially covers home infusion bundled services with prior authorization, though Part D home infusion drugs are not covered. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Blue Shield 65 Plus Choice Plan (HMO) with no copayment and a 20% coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Medical equipment is partially covered by the Blue Shield 65 Plus Choice Plan (HMO), featuring no copay and 0% to 20% coinsurance for durable medical equipment, and no copay and 20% coinsurance for prosthetic devices. 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 by the Blue Shield 65 Plus Choice Plan (HMO) with a doctor referral, though diagnostic procedures, tests, lab services, diagnostic radiological services, and outpatient X-ray services are not covered. Some diagnostic services are covered with no copay and no coinsurance, while covered therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered by the Blue Shield 65 Plus Choice Plan (HMO), requiring prior authorization and a doctor referral. Copay and coinsurance information is not specified for this benefit.
Cardiac Rehabilitation Services See details
Blue Shield 65 Plus Choice Plan (HMO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Blue Shield 65 Plus Choice Plan (HMO) partially covers Skilled Nursing Facility (SNF) care, requiring a doctor referral and prior authorization, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and a $75 daily copay for days 21 to 100, with no coinsurance required for covered stays.
Other Services See details
Other Services are partially covered by the Blue Shield 65 Plus Choice Plan (HMO), which offers a chronic illness meal benefit and an $80 allowance every three months for over-the-counter items with no copay or coinsurance. Acupuncture, Naloxone, and Dual Eligible SNPs are not covered under these services.
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