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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 Hernando and Pinellas 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 $3200.00 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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and whether you use a preferred or standard pharmacy. For example, you will pay a $0 copay for preferred generic drugs at standard or mail order pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay a $0 premium.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers comprehensive coverage including inpatient and outpatient hospital services, with copays varying by service. You'll find no copay for primary care, preventive services, hearing exams, and vision eyewear. Dental services also have no copay, while other services such as ambulance, emergency, and skilled nursing facilities have copays or coinsurance. This plan also includes additional benefits like transportation services, home health services, and coverage for medical equipment. It also offers coverage for home infusion bundled services, dialysis services, and a quarterly allowance for over-the-counter items. However, services like cardiac rehabilitation and certain other specialized services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $150 copay for days 1-6, and no copay for days 7-90; additional days have no copay. Inpatient Hospital Psychiatric services have a $175 copay for days 1-9, and no copay for days 10-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueMedicare Premier (HMO) plan, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $115, Observation Services have a $140 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a $20 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueMedicare Premier (HMO) plan, with a $20 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $280 copay and no coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 30 one-way trips per year, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the BlueMedicare Premier (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Premier (HMO) plan offers Primary Care, with no copay for Primary Care Physician Services. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $20 copay. Physician Specialist Services have a $0-$15 copay, and Mental Health Specialty Services have a $20 copay for individual and group sessions. Other Health Care Professional services have a $0-$20 copay, and Psychiatric Services have a $20 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $0-$20 copay, and Additional Telehealth Benefits have a $0-$20 copay. Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
The BlueMedicare Premier (HMO) plan covers preventive services, including Medicare-covered preventive services, with no copay. Additional preventive services, including fitness and support for caregivers, are covered, though some services like annual physical exams, health education, and various other services are not covered. Kidney disease education services and other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, are covered 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. Prescription hearing aids are covered with a copay between $350 and $1825, while inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
The BlueMedicare Premier (HMO) plan covers vision services including eye exams with a copay of $0-$15 and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $250 per year. Routine eye exams have no copay, and are limited to one per year.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers dental services, including Medicare Dental Services with a $15 copay, and other dental services with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay, while 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, and may require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Premier (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment and prosthetics, is covered by this plan. 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. Prosthetic devices have a 20% coinsurance, and medical supplies have no coinsurance. Diabetic equipment is covered, with no copay for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
The BlueMedicare Premier (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $50, and lab services with no copay. Diagnostic radiological services have a copay of at most $100, and 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. 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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
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, but for days 21-100, there is a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueMedicare Premier (HMO) plan's "Other Services" benefit covers over-the-counter items, with a maximum benefit coverage amount of $65.00 every three months, including Nicotine Replacement Therapy and Naloxone coverage. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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