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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 Broward 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 $4500.00 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 prescription 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, everyday medications are highly affordable for members. For higher-tier medications, costs are structured as coinsurance for standard pharmacy and mail order services. Tier 3 preferred brand drugs require 21% coinsurance, Tier 4 non-preferred drugs require 30% coinsurance, and Tier 5 specialty tier drugs carry a 25% coinsurance for a 1-month supply. This straightforward pricing structure helps you easily estimate your out-of-pocket prescription costs.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers affordable coverage for core healthcare needs, featuring no copay and no coinsurance for primary care visits, preventive care, and routine home health services. Specialist visits are highly accessible with copays ranging from no copay up to thirty-five dollars, while inpatient hospital stays require a daily copay of one hundred sixty dollars for the first seven days. Emergency room visits carry a one hundred thirty dollar copay, and outpatient hospital services feature no coinsurance with copays ranging from no copay up to one hundred fifty dollars. Members also benefit from comprehensive routine dental, vision, and hearing exams with no copays or coinsurance, including a two hundred twenty-five dollar annual allowance for eyewear. Diagnostic lab tests and outpatient X-rays are provided with no copay, though dialysis and therapeutic radiology require a twenty percent coinsurance. Durable medical equipment is available with no copays and zero to twenty percent coinsurance, while routine transportation, cardiac rehabilitation, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is covered by BlueMedicare Premier (HMO) with no coinsurance, requiring a $160 daily copay for days 1 to 7 of acute stays and a $175 daily 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) outpatient services feature no coinsurance across all covered services, with outpatient hospital copays ranging from $0 to $150 and observation services carrying a $130 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $50 copay and no coinsurance.
Partial Hospitalization See details
BlueMedicare Premier (HMO) covers partial hospitalization services with a $50 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueMedicare Premier (HMO), requiring prior authorization for ambulance services which carry a copay of up to $345 for ground transport and a 20% coinsurance for air transport. Routine transportation services to health-related locations are not covered.
Emergency Services See details
BlueMedicare Premier (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with 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, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Premier (HMO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Most other services, including therapy, mental health, and telehealth, are covered with copays ranging up to $50 and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by BlueMedicare Premier (HMO) with no copays and no coinsurance for covered benefits, which include Medicare-covered zero-dollar preventive services, kidney disease education, glaucoma screenings, and memory fitness. However, several services are not covered under this plan, such as annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by BlueMedicare Premier (HMO) with no copay or coinsurance for Medicare-covered exams, annual routine exams, and fitting evaluations, though a referral is required. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $350.00 to $1,825.00 for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
BlueMedicare Premier (HMO) vision services are partially covered, offering one annual routine eye exam with no copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contact lenses, eyeglasses, frames, lenses, and upgrades, is covered with no copay and no coinsurance up to a $225 annual maximum.
Dental Services See details
Dental services are partially covered under BlueMedicare Premier (HMO), with Medicare-covered dental services requiring a $35 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance. However, implant services, orthodontics, fixed prosthodontics, maxillofacial prosthetics, adjunctive general services, and other diagnostic dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BlueMedicare Premier (HMO) with prior authorization, featuring a $5.00 copay and no coinsurance for Part B insulin. Other covered Part B drugs, including chemotherapy and radiation, require a coinsurance ranging from 0% to 20%, with no copay for other Part B drugs, and step therapy may apply.
Dialysis Services See details
Dialysis services are covered under the BlueMedicare Premier (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Premier (HMO) covers medical equipment with no copays across all categories, including durable medical equipment (DME), prosthetics, and diabetic supplies. DME and prosthetic devices require prior authorization and carry 0% to 20% coinsurance, while medical and diabetic supplies are available with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueMedicare Premier (HMO) with prior authorization and referrals required. Diagnostic procedures and tests have a $0 to $25 copay with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by BlueMedicare Premier (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BlueMedicare Premier (HMO) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. Although the benefit technically features no coinsurance, members are responsible for the full cost of these services because they are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueMedicare Premier (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other Services are covered by BlueMedicare Premier (HMO), though in practice only some services are covered; acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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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.
* 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.
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