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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 Orange, Osceola & Seminole 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 $5000.00 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'll pay different copays depending on the drug tier and pharmacy. For example, generic drugs have a $10 or $40 copay, while preferred brand drugs have a $93 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The BlueMedicare Classic (HMO) plan offers a range of benefits with varying cost-sharing. This plan covers inpatient hospital stays with a copay, and also includes outpatient services, such as primary care, with no copay. The plan also provides coverage for hearing and vision services, as well as dental, with specific copays depending on the services. This plan also covers ambulance services, emergency services, and home health services. Additionally, it includes benefits like home infusion services, dialysis, and durable medical equipment. However, it's important to note that some services, such as cardiac rehabilitation and certain "other services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $185 copay for days 1-7, and no copay for days 8-90, with additional days 91-999 having no copay. For Inpatient Hospital Psychiatric, you pay a $270 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The BlueMedicare Classic (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $130, observation services with a $125 copay, and ambulatory surgical center services with no copay. Additionally, the plan covers outpatient substance abuse services, including individual and group sessions with a copay between $20 and $20, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Classic (HMO) plan, but requires prior authorization. You will have a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $250 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services and Urgently Needed Services, are covered by the BlueMedicare Classic (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay. 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, and Occupational Therapy Services with a $35 copay. It also covers Physician Specialist Services with a copay between $0 and $35, Mental Health Specialty Services with a $20 copay for individual and group sessions, and Other Health Care Professional services with a copay between $0 and $20. Additionally, it covers Psychiatric Services with a $20 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $35, Additional Telehealth benefits with a copay between $0 and $35, and Opioid Treatment Program Services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services with no copay. Additional preventive services are covered, but specific services like 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. Support for Caregivers of Enrollees, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Fitness Benefit has no copay. Kidney Disease Education Services have no copay.
Hearing Services See details
The BlueMedicare Classic (HMO) plan covers hearing exams and routine hearing exams with no copay, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered; the copay for prescription hearing aids ranges from $350 to $1825. OTC 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 $35, and eyewear with no copay. Eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, other dental services with no copay, and orthodontic services. Oral exams and prophylaxis (cleaning) are covered with no copay, while fluoride treatment is not covered. Prosthodontics, removable and oral and maxillofacial surgery are covered with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueMedicare Classic (HMO) plan. This includes coverage for Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay.
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
The BlueMedicare Classic (HMO) plan covers Durable Medical Equipment with no copay and a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered devices and supplies. Diabetic equipment is covered, 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
The BlueMedicare Classic (HMO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a maximum copay of $100, and lab services with no copay. Radiological services have a copay for diagnostic services of up to $250, and a 20% coinsurance for therapeutic services, while outpatient X-rays have a $25 copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Classic (HMO) plan with no copay and no coinsurance. 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's 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. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management (long term care), institution for mental disease services for individuals 65 or older, services in an intermediate care facility for individuals with intellectual disabilities, case management, tobacco cessation counseling for pregnant women, freestanding birth center services, respiratory care services, family planning services, nursing home services, home and community based services, personal care services, and self-directed personal assistance services. No authorization or referral is required for these 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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