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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 South, Central and North East Florida counties. 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 $5500.00 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 copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, standard generic drugs have a $10 copay at a standard pharmacy, while preferred brand drugs have a $93 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The BlueMedicare Classic (HMO) plan offers a range of benefits with varying costs. Hospital stays have copays depending on the type and length of stay. Outpatient services, including primary care, have a mix of no copays and copays, while emergency services and ambulance services have copays. Preventive services, hearing exams, and vision exams often have no copay, and there are no copays for many dental services. The plan also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring coinsurance. This plan does not cover cardiac rehabilitation services or other services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $145 copay for days 1-6, and no copay for days 7-90; Additional Days have no copay. For Inpatient Hospital Psychiatric, you will pay a $245 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the BlueMedicare Classic (HMO) plan, including outpatient hospital services with a copay between $0 and $100, observation services with a $125 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Classic (HMO) plan, but prior authorization is required. You will pay a $20 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Classic (HMO) plan. Both ground and air ambulance services have a $250 copay, with no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency and Urgent Coverage, are covered by the BlueMedicare Classic (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, while there is a $125 copay for both Worldwide Emergency Coverage and Worldwide Urgent Coverage. Worldwide Emergency Transportation is not covered, and Worldwide Emergency Services have a maximum benefit of $25,000.
Primary Care See details
The BlueMedicare Classic (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a $0-$49 copay, mental health specialty services with a $20 copay for individual and group sessions, and other health care professional services with a $0-$20 copay. Furthermore, it covers psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $0-$35 copay, additional telehealth benefits with a $0-$49 copay, and opioid treatment program services with a $20 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, with no copay, and additional preventive services, with no copay for Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $350 and $1825, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BlueMedicare Classic (HMO) plan covers vision services including eye exams with a copay of $0-$49, and eyewear with a combined maximum benefit of $100 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The BlueMedicare Classic (HMO) plan covers Medicare and other dental services, with a $49 copay for Medicare dental services. Oral exams, dental x-rays, prophylaxis (cleaning), removable prosthodontics, and oral and maxillofacial surgery are covered with no copay. 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 by the BlueMedicare Classic (HMO) plan. Insulin has a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Classic (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueMedicare Classic (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $225, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by BlueMedicare Classic (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Classic (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Classic (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. 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 BlueMedicare Classic (HMO) plan. This includes acupuncture, over-the-counter items, meal benefits, and other services.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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