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BlueMedicare Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Classic (HMO) in 2025, please refer to our full plan details page.
BlueMedicare Classic (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare Classic (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 BlueMedicare Classic (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 BlueMedicare Classic (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 $3900.00 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 BlueMedicare Classic (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a $0 copay for preferred generic drugs at a standard pharmacy and through mail order. You will pay a $15 copay for standard generic drugs and a $93 copay for preferred brand drugs at a standard pharmacy or through mail order. For non-preferred drugs, you will pay 33% coinsurance at a standard pharmacy or through mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Classic (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays ranging from $0 to $125. Emergency services and ambulance services are covered, but transportation to health-related locations is not. The plan provides coverage for primary care, hearing, vision, and dental services with copays that vary depending on the service. Home health services, durable medical equipment, and skilled nursing facilities are also covered with some cost-sharing. However, certain services like cardiac rehabilitation and some "other services" are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the BlueMedicare Classic (HMO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $110 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $175 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered by the BlueMedicare Classic (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $40, while observation services have a $125 copay. Ambulatory surgical center services and outpatient blood services have no copay, and individual and group sessions for outpatient substance abuse have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Classic (HMO) plan, but requires prior authorization. The plan has a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Classic (HMO) plan. Ground and Air Ambulance Services have a $245 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the BlueMedicare Classic (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $5. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Classic (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $10 and $40, and physician specialist services with a copay between $0 and $20. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services with a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $40, and additional telehealth benefits have a copay between $0 and $40. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services and other preventive services. Annual physical exams, health education, 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, nutritional/dietary benefits, home-based palliative care, in-home support services, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a copay between $350 and $1825, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
The BlueMedicare Classic (HMO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay. Routine eye exams are covered with no copay, once per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay, with a combined maximum benefit of $100 per year for all eyewear.
Dental Services See details
Dental Services are covered under the BlueMedicare Classic (HMO) plan, with a $20 copay for Medicare Dental Services and no copay for Other Dental Services. Oral exams, dental x-rays, prophylaxis (cleaning), prosthodontics (removable), and oral and maxillofacial surgery are covered, while fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the BlueMedicare Classic (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with no coinsurance. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, with a copay for some services ranging from $0 to $30. Diagnostic Radiological Services have a copay up to $100, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Classic (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Classic (HMO) plan. Prior authorization and a doctor referral are required for these services, but the plan does not cover them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Classic (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the BlueMedicare Classic (HMO) plan, including acupuncture, over-the-counter items, meal benefits, and more. No authorization or referral is required for these services.
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