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FHCP Medicare Rx Savings (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for FHCP Medicare Rx Savings (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on FHCP Medicare Rx Savings (HMO) in 2025, please refer to our full plan details page.
FHCP Medicare Rx Savings (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Counties: BRE, FLA, SEM, SJO and VOL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that FHCP Medicare Rx Savings (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 FHCP Medicare Rx Savings (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 FHCP Medicare Rx Savings (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. Additionally, this plan comes with a Part B Premium reduction of $82.00. You must continue to pay paying your reduced 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 $590.00 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 $9350.00 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 FHCP Medicare Rx Savings (HMO) plan has a $590 deductible. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For Tier 1 preferred generic drugs, you will pay a $10 copay at a preferred pharmacy or a $20 copay at a standard pharmacy. Tier 5 specialty drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The FHCP Medicare Rx Savings (HMO) plan provides coverage for a wide range of services. Inpatient hospital stays have a copay, while outpatient services can have a copay between $0 and $400. Emergency services have a $100 copay, and primary care visits have a $20 copay. Preventive services and home health services have no copay, while hearing exams have a $45 copay and vision exams have a $15 copay. The plan also covers dental services with a $50 copay. The plan does not cover other services, including acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $500 for days 1-4 and no copay for days 5-90 for acute care, and a copay of $465 for days 1-4 and no copay for days 5-90 for psychiatric care. Additional days for both acute and psychiatric care have no copay, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $400, while observation services have a $400 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and outpatient substance abuse services have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the FHCP Medicare Rx Savings (HMO) plan, and requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the FHCP Medicare Rx Savings (HMO) plan. Ground and Air Ambulance Services have a $300 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the FHCP Medicare Rx Savings (HMO) plan. Emergency Services has a $100 copay, Urgently Needed Services has a copay between $20 and $45, and Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary care physician visits have a $20 copay, chiropractic services have a $15 copay, occupational therapy has a $20 copay, physician specialist visits have a $50 copay, and other health care professionals have a copay between $0 and $20. Mental health, psychiatric services, and opioid treatment have a $40 copay for individual and group sessions, physical therapy and speech-language pathology services have a copay between $0 and $20, and additional telehealth benefits have a copay between $0 and $30. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The FHCP Medicare Rx Savings (HMO) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services with a doctor referral. Kidney disease education services are covered with no copay, and other preventive services include services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Annual physical exams, in-home safety assessments, personal emergency response systems, 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, 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 are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, each with no coinsurance. Hearing exams have a $45 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but only prescription hearing aids (all types) have no copay, and the plan covers a maximum of $300 per year. OTC hearing aids are not covered.
Vision Services See details
The FHCP Medicare Rx Savings (HMO) plan covers vision services, including routine eye exams with a copay of $15, and eyeglasses (lenses and frames) with no copay, up to a maximum of $90 every two years. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the FHCP Medicare Rx Savings (HMO) plan, with a $50 copay for Medicare Dental Services, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered. Prior authorization and a doctor referral are required for Medicare Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the FHCP Medicare Rx Savings (HMO) plan and require a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the FHCP Medicare Rx Savings (HMO) plan, with no copay. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered under the FHCP Medicare Rx Savings (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $300, Lab Services have no copay, Diagnostic Radiological Services have a copay between $10 and $200, Therapeutic Radiological Services have a copay between $10 and $50, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by FHCP Medicare Rx Savings (HMO) with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the FHCP Medicare Rx Savings (HMO) plan, with a doctor referral and prior authorization required. There is no copay for days 1-20, and a $172 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the FHCP Medicare Rx Savings (HMO) plan. Specifically, 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 are not covered.
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