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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 Clay and Duval 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 $3500.00 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. There is no deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic drugs and a $40 copay for standard generic drugs. For preferred brand drugs, the copay is $93, and for non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers comprehensive coverage with a variety of benefits. The plan includes no copay for primary care physician services, outpatient blood services, and preventive services, as well as no copay for many other services such as vision eyewear and dental services. You can expect copays for inpatient hospital stays, outpatient services, ambulance services, and emergency services. This plan also covers services such as hearing exams, vision services, and dental services. There is also coverage for home health services with no copay, and coverage for skilled nursing facilities. The plan covers a wide range of services, and has a $50 every three months allowance for over-the-counter (OTC) items.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the BlueMedicare Premier (HMO) plan. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-5, and no copay for days 6-90; additional days from 91-999 have no copay. For Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-9, and no copay for days 10-90. 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
Outpatient Services are covered by the BlueMedicare Premier (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$125, Observation Services have a $140 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Premier (HMO) plan, but requires prior authorization. There is a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the BlueMedicare Premier (HMO) plan. Ground and air ambulance services have a $225 copay, and transportation services to a plan-approved health-related location have no copay for up to 30 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the BlueMedicare Premier (HMO) plan, with a $140 copay, but the copay is waived if admitted to the hospital within 48 hours; Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage both have a $140 copay, while Worldwide Emergency Transportation is not covered. Worldwide emergency services have a maximum plan benefit of $25,000.
Primary Care See details
The BlueMedicare Premier (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $20 copay, and physician specialist services have a copay between $0 and $20. Mental health specialty services, psychiatric services, and opioid treatment program services also have a $20 copay for individual and group sessions.
Preventive Services See details
Preventive Services are covered by the BlueMedicare Premier (HMO) plan. Medicare-covered Zero Dollar Preventive Services, Kidney Disease Education Services, and Other Preventive Services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. Additional Preventive Services are covered, however, 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. The plan also covers Support for Caregivers of Enrollees and Fitness Benefits, both with no copay.
Hearing Services See details
The BlueMedicare Premier (HMO) plan covers hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay and limited to one visit per year. Prescription hearing aids are covered with a copay between $350 and $1825, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$20, and eyewear with no copay. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is a combined maximum plan benefit coverage amount of $275 for all eyewear, every year.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers Medicare Dental Services with a $20 copay and Other Dental Services with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are also covered with no copay. However, 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, requiring 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 benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while 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, including diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $100, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Premier (HMO) plan with no copay and no coinsurance; however, 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 Premier (HMO) plan. Prior authorization and a doctor's referral are required for this benefit.
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, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The BlueMedicare Premier (HMO) plan covers Over-the-Counter (OTC) Items, offering up to $50 every three months. However, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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