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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 Clay and Duval counties. 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 $5500.00 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. Under this plan, you will enjoy no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions filled at standard pharmacies or through standard mail order for both 1-month and 3-month supplies. This makes managing everyday maintenance medications highly affordable. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. You will pay 21% coinsurance for Tier 3 (Preferred Brand) drugs, 30% coinsurance for Tier 4 (Non-Preferred) drugs, and 25% coinsurance for Tier 5 (Specialty Tier) drugs when using standard retail pharmacies or standard mail order. These coinsurance rates apply to 1-month and 3-month supplies, except for Specialty Tier drugs which are limited to a 1-month supply.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers robust healthcare coverage with budget-friendly cost-sharing, including no copays and no coinsurance for primary care doctor visits, preventive care, and home health services. Specialist visits, urgent care, and emergency room services are accessible with predictable copays and no coinsurance. For inpatient hospital stays and skilled nursing facility care, members pay daily copays for a limited number of days, with no copays required for subsequent days of the stay. This plan also includes key supplemental benefits, featuring routine dental care, annual hearing exams, and vision exams with no copays and no coinsurance. While prescription hearing aids require a copay, covered eyewear is available with no copays up to a combined annual maximum limit. Additionally, members benefit from no copays on diagnostic lab work and many types of durable medical equipment, helping to keep overall healthcare costs low.
Inpatient Hospital See details
Inpatient hospital care is covered by BlueMedicare Premier (HMO) with no coinsurance, requiring a $300 daily copay for days 1-7 of acute stays (no copay for days 8 and beyond) and a $200 daily copay for days 1-7 of psychiatric stays (no copay for days 8-90). This benefit is partially covered, as 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 ambulatory surgical center and outpatient blood services which feature no copays. Outpatient hospital services require prior authorization and have a copay of $0 to $225, while observation services cost a $130 copay per stay. Outpatient substance abuse services also have no coinsurance but require prior authorization, with copays of $40 for individual sessions and $30 for group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by BlueMedicare Premier (HMO) with a $50.00 copay and no coinsurance, although 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 $345 plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay, both of which require prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered under this plan.
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 urgent care with a $50 copay and no coinsurance. Worldwide emergency and urgent services 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) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $45 copay and no coinsurance. Other covered services like physical therapy, occupational therapy, telehealth, and mental health services have copays ranging from $0 to $50 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by BlueMedicare Premier (HMO) with no copay and no coinsurance for covered services, including Medicare-covered zero-dollar preventive care, kidney disease education, glaucoma screenings, diabetes training, and memory fitness. This benefit does not cover an annual physical exam, health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary services, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home safety devices, or counseling.
Hearing Services See details
BlueMedicare Premier (HMO) covers routine hearing exams and fitting evaluations annually with no copay, no coinsurance, and no deductible, 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 OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Premier (HMO), featuring a $0 to $45 copay and no coinsurance for eye exams, though other eye exam services are not covered. Covered eyewear, including lenses, frames, and contacts, has no copay and no coinsurance up to a $225 combined maximum limit per year.
Dental Services See details
BlueMedicare Premier (HMO) partially covers dental services, offering Medicare-covered dental with a $45 copay and no coinsurance, and other covered dental benefits with no copay and no coinsurance. Excluded from coverage are other diagnostic dental services, adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueMedicare Premier (HMO) with prior authorization required, featuring a $35 copay and 0% to 20% coinsurance for Medicare Part B insulin. Other covered Part B drugs require no copay, while chemotherapy and radiation drugs are subject to a copay, with both categories carrying a 0% to 20% coinsurance.
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 for durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. Coinsurance ranges from 0% to 20% for DME and is 20% for prosthetic devices, while medical supplies and diabetic equipment carry no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueMedicare Premier (HMO), requiring prior authorization and referrals. Diagnostic services have no coinsurance, featuring no copay for lab services and a copay of $0 to $50 for diagnostic procedures, while radiological services feature a $0 minimum copay for diagnostic radiology, no copay for X-rays, and a 20% coinsurance for therapeutic radiology.
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 covered by BlueMedicare Premier (HMO) with no coinsurance, though prior authorization and referrals are required. While some services are covered, specific sub-services—including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)—are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is partially covered by BlueMedicare Premier (HMO) with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, and prior authorization is required.
Other Services See details
Other Services are not covered under the BlueMedicare Premier (HMO) plan, meaning there is no coverage or cost-sharing availability for acupuncture, over-the-counter (OTC) items, or meal benefits.
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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.
* 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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