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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 2026, 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 4 out of 5 stars in 2026.
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 a $615.00 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 $6750.00 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 features an annual drug deductible of $615 for prescription drug coverage. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to both 1-month and 3-month supplies of these lower-tier medications. For brand-name and specialty drugs, you will pay a coinsurance rather than a copay. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty tier drugs require a 25% coinsurance for a 1-month supply at standard pharmacies or standard mail order.
Additional Benefits
The BlueMedicare Classic (HMO) plan offers comprehensive coverage for essential medical services with no coinsurance for inpatient hospital stays, outpatient care, and doctor visits. Patients enjoy no copay for primary care visits, while specialist visits range from no copay up to $55, and inpatient hospital stays require a $345 daily copay for the first seven days. Emergency room visits carry a $130 copay, which is waived if admitted within 48 hours, and urgent care services require a $50 copay. Preventive dental, routine vision, and routine hearing exams are covered with no copay or coinsurance, though prescription hearing aids require copays between $350 and $1,825. Skilled nursing facility care features no copay for the first 20 days, and durable medical equipment is covered with no copays and a 0% to 20% coinsurance. However, some services are not covered under this plan, including routine transportation, over-the-counter items, acupuncture, and meal benefits.
Inpatient Hospital See details
BlueMedicare Classic (HMO) covers inpatient hospital services with no coinsurance, but prior authorization is required. For acute stays, you pay a $345 daily copay for days 1-7 and no copay for days 8 and beyond, whereas psychiatric stays require a $295 daily copay for days 1-7 and no copay for days 8-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under BlueMedicare Classic (HMO) are covered with no coinsurance, featuring a $0 to $230 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse services carry a $30 to $40 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BlueMedicare Classic (HMO) with a $50.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
BlueMedicare Classic (HMO) covers ambulance services with prior authorization, requiring a copay of $0 to $305 plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services are not covered in practice, as trips to plan-approved and any other health-related locations are not covered.
Emergency Services See details
BlueMedicare Classic (HMO) covers emergency services with a $130 copay—waived if admitted to the hospital within 48 hours—and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Classic (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with copays ranging from no copay to $55 and no coinsurance. Other covered benefits, including therapy, mental health, and telehealth, require copays up to $55 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
BlueMedicare Classic (HMO) preventive services are partially covered with no copay and no coinsurance for covered services, which include Medicare-covered zero-dollar preventive services, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. However, an annual physical exam and various supplemental services—such as health education, in-home safety assessments, and personal emergency response systems—are not covered.
Hearing Services See details
BlueMedicare Classic (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, although a referral is required. Prescription hearing aids are partially covered with no coinsurance and copayments ranging from $350.00 to $1,825.00 for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Classic (HMO) with no coinsurance, offering one routine eye exam per year with no copay (referral required), while other eye exam services are not covered. Eyewear, including lenses and frames, is covered with no copay up to a combined annual limit of $100.
Dental Services See details
BlueMedicare Classic (HMO) dental services are partially covered, featuring a $55 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive care, removable prosthodontics, and oral surgery. Sub-services not covered under this plan include fluoride, other diagnostic or preventive services, restorative services, endodontics, periodontics, implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, and adjunctive general services.
Home Infusion bundled Services See details
BlueMedicare Classic (HMO) covers home infusion bundled services with prior authorization, requiring a 0% to 20% coinsurance and applicable copayments for chemotherapy and radiation drugs. Part B insulin is covered with a $35 copay and 0% to 20% coinsurance, other Part B drugs have no copay, and step therapy may apply.
Dialysis Services See details
Dialysis services are covered by BlueMedicare Classic (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Classic (HMO) covers medical equipment with no copays across all categories, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. While medical supplies and diabetic equipment carry no coinsurance, DME and prosthetics require prior authorization and have a coinsurance ranging from 0% to 20%.
Diagnostic and Radiological Services See details
BlueMedicare Classic (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for both. Diagnostic services feature no coinsurance, with no copay for lab tests and a $0 to $30 copay for diagnostic procedures, while radiological services range from a $10 copay for X-rays to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
BlueMedicare Classic (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueMedicare Classic (HMO) with no coinsurance, though only some services are covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Classic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BlueMedicare Classic (HMO) does not cover Other Services, meaning supplemental benefits such as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered by this plan.
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