A non-government entity
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 Orange, Osceola & Seminole 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:
Sign up for BlueMedicare Classic (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueMedicare Classic (HMO) prescription drug plan features an annual drug deductible of $615. 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 ensures that many common medications are available with no copayment for both 1-month and 3-month supplies. For higher-tier medications, costs are determined by coinsurance during the initial coverage phase. You will pay a 21% coinsurance for Tier 3 preferred brand drugs and a 30% coinsurance for Tier 4 non-preferred drugs. Specialty drugs in Tier 5 require a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The BlueMedicare Classic (HMO) plan offers affordable medical coverage with no copay for primary care visits and a $55 copay for specialist consultations. Inpatient hospital stays feature a $385 copay for days 1 through 7 and no copay for subsequent days, while outpatient hospital services range from no copay to a $230 copay. Emergency room visits require a $130 copay, which is waived if you are admitted to the hospital within 48 hours. Supplemental benefits include routine dental, vision, and hearing exams with no copay, alongside a $100 annual allowance for eyewear and partial coverage for hearing aids. Additionally, members pay no copay for diabetic supplies and 0% to 20% coinsurance for durable medical equipment. This plan helps keep healthcare affordable by charging no coinsurance for the vast majority of its covered medical and hospital services.
Inpatient Hospital See details
BlueMedicare Classic (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $385 copay for days 1 through 7 and no copay for days 8 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, featuring a $320 copay for days 1 through 7 and no copay for days 8 through 90, while additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Classic (HMO) covers outpatient services with no coinsurance, featuring a $0 to $230 copay for outpatient hospital services and no copay for ambulatory surgical center or blood services. Outpatient substance abuse services are also covered with no coinsurance and copays of $30 for group sessions or $40 for individual sessions.
Partial Hospitalization See details
BlueMedicare Classic (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
BlueMedicare Classic (HMO) covers ground ambulance services with a copay ranging from no copay to $300 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under BlueMedicare Classic (HMO) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Classic (HMO) primary care benefits feature no copay and no coinsurance for primary care physician services, while specialist visits require a $55 copay and no coinsurance. Other covered services like physical therapy, mental health, and telehealth have copays ranging from $0 to $55 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by BlueMedicare Classic (HMO) with no copay and no coinsurance for covered benefits such as Medicare-covered preventive care, kidney disease education, and a memory fitness benefit. Non-covered services under this benefit include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
BlueMedicare Classic (HMO) covers hearing services with no deductible, offering routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $55 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $350 to $1,825 for up to two devices per year, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
BlueMedicare Classic (HMO) offers partially covered vision services with no deductibles, though other eye exam services are not covered. Eye exams are covered with no coinsurance and a copay ranging from $0 to $55 with a required referral, while contact lenses and eyeglasses are covered with no copay and no coinsurance up to a $100 annual maximum.
Dental Services See details
BlueMedicare Classic (HMO) partially covers dental services, offering Medicare-covered dental with a $55 copay and no coinsurance, and select preventive and comprehensive services—such as cleanings, exams, x-rays, oral surgery, and removable prosthodontics—with no copay and no coinsurance. Non-covered services include fluoride, restorative, endodontics, periodontics, implants, fixed prosthodontics, orthodontics, other diagnostic, other preventive, adjunctive general, and maxillofacial prosthetics.
Home Infusion bundled Services See details
BlueMedicare Classic (HMO) covers Home Infusion bundled Services with prior authorization, offering Medicare Part B insulin for a $35 copay and no coinsurance to 20% coinsurance. Other covered Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, with other Part B drugs having no copay.
Dialysis Services See details
BlueMedicare Classic (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Classic (HMO) covers medical equipment with no copays, offering diabetic supplies and medical supplies with no coinsurance, prosthetic devices with 20% coinsurance, and durable medical equipment (DME) with 0% to 20% coinsurance. Prior authorization is required for DME and prosthetics, which are both covered with no manufacturer or preferred vendor limitations.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under BlueMedicare Classic (HMO) with prior authorization and referral requirements, featuring no copay or coinsurance for lab services and a $0 to $100 copay with no coinsurance for diagnostic tests. Outpatient X-rays require a $25 copay plus coinsurance, diagnostic radiological services have no minimum copay, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
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
BlueMedicare Classic (HMO) provides coverage for Cardiac Rehabilitation Services with no coinsurance, but requires a referral and prior authorization. Some services are covered, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Classic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering 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 needed, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are not covered under the BlueMedicare Classic (HMO) plan, which does not provide coverage for acupuncture, over-the-counter (OTC) items, or meal benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved