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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 2025, 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 Orange & Osceola counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 has an enhanced alternative drug benefit. The plan has a $0 deductible. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at standard and mail order pharmacies. Standard generic drugs have a $15 copay. For preferred brand drugs, you will pay a $93 copay. For non-preferred drugs, you will pay 33% coinsurance.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including some hospital and substance abuse services, also have copays. Emergency services, primary care, and preventive services often have no copay, and the plan covers hearing, vision, and dental services, with copays for some services. The plan covers ambulance and transportation, as well as home health and skilled nursing facility services. Additionally, this plan covers medical equipment, diagnostic services, and home infusion. Other benefits include a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $100 copay for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a $150 copay for days 1-9 and no copay for days 10-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $75, Observation Services with a $140 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $20 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Premier (HMO) plan. Ground and air ambulance services have a $225 copay, while transportation services to a plan-approved health-related location have no copay and cover up to 30 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueMedicare Premier (HMO) plan, with copays of $140, $20, and $140, respectively, and no coinsurance. Worldwide Emergency Transportation is not covered under this plan.
Primary Care See details
The BlueMedicare Premier (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $25 copay. Physician specialist services, mental health specialty services, and physical therapy and speech-language pathology services have copays ranging from $0 to $25. Other health care professional services have copays from $0 to $20. Individual and group sessions for psychiatric services and opioid treatment program services have a $20 copay. Additional telehealth benefits have copays ranging from $0 to $25. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, while additional services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered. Other covered services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The BlueMedicare Premier (HMO) plan covers hearing exams with no copay, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $350 and $1825, however, inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The BlueMedicare Premier (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $25, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, frames, and upgrades, are covered with no copay, and the plan offers a combined maximum of $300 per year for eyewear.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers Medicare Dental Services with a $25 copay, and other dental services with no copay. The plan also covers Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery with no copay, but Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Premier (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay, and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices have a 20% coinsurance, and Medical Supplies have no coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, and lab services with no copay. Diagnostic Radiological Services have a copay of up to $150, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Premier (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor's referral are required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Premier (HMO) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $65.00 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone, but it does not cover Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, or other listed services.
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