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BlueMedicare Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Premier (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Premier (HMO) in 2026, please refer to our full plan details page.
BlueMedicare Premier (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Palm Beach County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BlueMedicare Premier (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 Premier (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 Premier (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 $4200.00 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 Premier (HMO) plan features an annual drug deductible of $615. Fortunately, members pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled as 1-month or 3-month supplies at standard pharmacies or standard mail order. For higher-tier medications, costs are based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs carry a 21% coinsurance, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers comprehensive coverage designed to keep your out-of-pocket costs low for everyday healthcare. Beneficiaries enjoy no copay and no coinsurance for primary care visits, home health care, routine vision exams, and covered preventive services. Additionally, the plan features a $20 copay for specialist visits and provides up to $3,000 in dental benefits with no copay or coinsurance. For more intensive medical needs, this plan offers predictable copays with no coinsurance for most inpatient and outpatient hospital services. Patients pay a $225 copay per day for days 1 to 7 of acute inpatient stays, a $140 copay for outpatient hospital services, and no copay for the first 20 days in a skilled nursing facility. Some specialized care, such as dialysis and durable medical equipment, will require a coinsurance of up to 20 percent.
Inpatient Hospital See details
BlueMedicare Premier (HMO) offers partially covered inpatient hospital services with no coinsurance, requiring a $225 copay for days 1 to 7 of acute stays and a $250 copay for days 1 to 7 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Premier (HMO) covers outpatient services with no coinsurance, including outpatient hospital services for a $140 copay, observation services for a $150 copay per stay, and ambulatory surgical center services for a $115 copay. Outpatient substance abuse services feature no coinsurance and a copay of $30 for group sessions or $40 for individual sessions, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
BlueMedicare Premier (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 Premier (HMO) covers ground ambulance services with a copay ranging from no copay to $330 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are not covered.
Emergency Services See details
BlueMedicare Premier (HMO) covers emergency services with a $150 copay (waived if admitted within 48 hours) and no coinsurance, and urgent care with a $65 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 limit with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Premier (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Other covered benefits, including physical therapy, occupational therapy, and mental health services, feature copays ranging from $0 to $40 with no coinsurance, though podiatry is not covered and chiropractic care is only partially covered with routine and other chiropractic services excluded.
Preventive Services See details
Preventive Services are partially covered under BlueMedicare Premier (HMO) with no copay and no coinsurance for covered options such as kidney disease education, memory fitness, glaucoma screenings, diabetes training, digital rectal exams, and EKGs. However, the plan does not cover 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 counseling, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety devices, and counseling.
Hearing Services See details
BlueMedicare Premier (HMO) covers hearing services with no coinsurance, offering Medicare-covered exams for a $20 copay and annual routine exams and fitting evaluations with no copay. Prescription hearing aids are partially covered with a copay ranging from $350 to $1,825 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
BlueMedicare Premier (HMO) offers partially covered vision services with no coinsurance, featuring no copay for routine eye exams and eyewear up to a $225 annual limit. Other eye exam services are not covered, and eye exams require a referral and may carry a copay of up to $20.
Dental Services See details
Dental Services are partially covered by BlueMedicare Premier (HMO), with Medicare-covered dental requiring a $20 copay and no coinsurance, and other preventive and comprehensive services covered up to $3,000 annually with no copay and no coinsurance. This plan does not cover adjunctive general services, implant services, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BlueMedicare Premier (HMO) subject to prior authorization. Covered Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%, while other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
BlueMedicare Premier (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Premier (HMO) covers medical equipment with no copays, featuring coinsurance ranging from 0% to 20% for durable medical equipment and 20% coinsurance for prosthetic devices. Covered medical supplies and diabetic equipment, including therapeutic shoes and inserts, require no copays and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Premier (HMO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $50 copay for diagnostic tests. Radiological services require prior authorization and referrals, featuring no copay for diagnostic radiological services and outpatient X-rays (which require coinsurance) and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
BlueMedicare Premier (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 under BlueMedicare Premier (HMO) with no coinsurance, though only some services are covered in practice. Specifically, cardiac rehabilitation ($35 copay), intensive cardiac ($50 copay), pulmonary ($20 copay), and SET for PAD ($20 copay) services are not covered, and prior authorization and referrals are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueMedicare Premier (HMO) with no coinsurance and no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
BlueMedicare Premier (HMO) provides partial coverage for other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a $50 allowance every three months. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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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.
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