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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 South, Central and North East Florida counties. 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. Under this plan, you will pay no copay for 1-month and 3-month supplies of Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) filled through standard pharmacies or standard mail order. This makes common and select generic medications highly affordable for plan members. For higher-tier medications, your costs are based on coinsurance rather than flat copays. You will pay 21% coinsurance for Tier 3 (Preferred Brand) drugs and 30% coinsurance for Tier 4 (Non-Preferred) drugs for both 1-month and 3-month standard fills. Tier 5 (Specialty) drugs require a 25% coinsurance for a 1-month supply through standard pharmacies or standard mail order.
Additional Benefits
The BlueMedicare Classic (HMO) plan offers robust medical coverage featuring no copay for primary care doctor visits and routine preventive services. For specialist visits, outpatient hospital services, and emergency care, members pay set copays with no coinsurance required for most of these services. Inpatient hospital stays require a $345 daily copay for the first seven days, followed by no copay for unlimited additional days. Members also benefit from no copays on routine dental, vision, and hearing exams, though advanced care like hearing aids and prescription eyewear involve additional copays or allowance limits. Skilled nursing facility stays are covered with no copay for the first 20 days, before transitioning to a daily copay of $218. Note that this plan does not cover certain extra benefits such as acupuncture, over-the-counter items, or meal services.
Inpatient Hospital See details
BlueMedicare Classic (HMO) covers inpatient acute hospital stays with no coinsurance, requiring prior authorization and a $345 daily copay for days 1-7, followed by no copay for unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance and requires prior authorization, carrying a $295 daily copay for days 1-7 and no copay for days 8-90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Classic (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay between $0 and $250, observation services have a $130 copay per stay, and outpatient substance abuse sessions carry a $60 copay.
Partial Hospitalization See details
BlueMedicare Classic (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under BlueMedicare Classic (HMO) cover ground ambulance services with a copay of no copay to $310 and applicable coinsurance, and air ambulance services with a 20% coinsurance and an applicable copay, both requiring prior authorization. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by BlueMedicare Classic (HMO) with a $130 copay (waived if admitted within 48 hours) and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum with a $130 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Classic (HMO) provides primary care physician services with no copay and no coinsurance, while specialists require a $40 to $55 copay and no coinsurance. Physical, occupational, and speech therapy services have copays ranging from $0 to $50 with no coinsurance, and mental health sessions have a $60 copay with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by BlueMedicare Classic (HMO) with no copay and no coinsurance for covered services such as kidney disease education, glaucoma screenings, diabetes self-management, and a memory fitness benefit. However, annual physical exams, health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits are not covered.
Hearing Services See details
BlueMedicare Classic (HMO) covers hearing services with a $40 copay and no coinsurance for Medicare-covered exams, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $350 to $1,825, though OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
BlueMedicare Classic (HMO) partially covers vision services, offering eye exams with no coinsurance and copays ranging from no copay to $55 with no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $100 annual maximum, which includes contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by BlueMedicare Classic (HMO), featuring a $55 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for exams, cleanings, x-rays, removable prosthodontics, and oral surgery. Specific sub-services including other diagnostic, fluoride, restorative, endodontic, periodontic, implant, fixed prosthodontic, and orthodontic services are not covered.
Home Infusion bundled Services See details
BlueMedicare Classic (HMO) covers home infusion bundled services with prior authorization, requiring no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while other Part B drugs have no copay.
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, though coinsurance ranges from 0% to 20% depending on the item. Durable medical equipment and prosthetic devices require up to 20% coinsurance, while medical and diabetic supplies are offered with no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Classic (HMO) covers diagnostic and radiological services with no coinsurance for diagnostic procedures, featuring no copay for lab services and outpatient x-rays, and a copay of $0 to $100 for diagnostic tests. Diagnostic radiological services have no copay, while therapeutic radiological services require a minimum 20% coinsurance, with prior authorizations and referrals required for these services.
Home Health Services See details
Home health services are covered by BlueMedicare Classic (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under BlueMedicare Classic (HMO), though in practice only some services are covered because standard cardiac (with a $25 copay), intensive cardiac (with a $50 copay), pulmonary (with a $15 copay), and SET for PAD (with a $25 copay) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Classic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the BlueMedicare Classic (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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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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