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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 Hernando and Pinellas 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. Beneficiaries can save significantly on everyday medications, as there is no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. You will pay a 21% coinsurance for Tier 3 preferred brand drugs, a 30% coinsurance for Tier 4 non-preferred drugs, and a 25% coinsurance for Tier 5 specialty drugs through standard pharmacy and mail-order channels.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers comprehensive medical coverage with many essential services featuring no copays or coinsurance. Members enjoy no copay for primary care doctor visits, routine eye and hearing exams, home health services, and preventive care. For hospital care, inpatient stays require a $300 daily copay for the first seven days and no copay for subsequent days, while outpatient services range from no copay to a $215 copay with no coinsurance. Additional benefits include dental, vision, and hearing coverage, featuring no copay for preventive dental work and up to $225 annually for eyewear. Emergency care is covered with a $130 copay, and standard diabetic and medical supplies are provided with no copay or coinsurance. Diagnostic lab tests and X-rays also carry no copay, though durable medical equipment and dialysis services require up to 20% coinsurance.
Inpatient Hospital See details
BlueMedicare Premier (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $300 daily copay for days 1 to 7 and no copay for days 8 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is also covered with no coinsurance, featuring a $225 daily copay for days 1 to 7 and no copay for days 8 to 90, though additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueMedicare Premier (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $215 for outpatient hospital services, $130 per stay for observation services, and $185 for ambulatory surgical center visits. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
BlueMedicare Premier (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance, though 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 $290 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered.
Emergency Services See details
BlueMedicare Premier (HMO) covers emergency services with a $130 copay, waived if admitted to the hospital within 48 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Premier (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $45 copay and no coinsurance. Additional covered benefits, including mental health, physical therapy, and telehealth services, feature copays ranging from $0 to $50 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by BlueMedicare Premier (HMO) with no copay and no coinsurance for Medicare-covered preventive care, kidney disease education, and select screenings like glaucoma and diabetes self-management. This benefit is partially covered, as the plan includes a memory fitness benefit with no copay but excludes annual physical exams, health education, and in-home safety assessments.
Hearing Services See details
BlueMedicare Premier (HMO) partially covers hearing services, offering no copay or coinsurance for Medicare-covered exams, one routine exam, and one fitting evaluation per year with a referral. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $350 to $1,825, but over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Premier (HMO), offering no copay and no coinsurance for one routine eye exam per year and covered eyewear up to a $225 annual limit. While contact lenses, eyeglasses, frames, and upgrades are covered with no copay or coinsurance, other eye exam services are not covered.
Dental Services See details
BlueMedicare Premier (HMO) partially covers dental services, offering Medicare-covered dental care with a $45 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance. Non-covered services include 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 under BlueMedicare Premier (HMO) with prior authorization and step therapy requirements. Part B insulin is covered with a $35 copay and 0% to 20% coinsurance, while other Part B drugs, including chemotherapy, carry 0% to 20% coinsurance and no copay for standard Part B drugs.
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 durable medical equipment (DME) and prosthetics with no copay and coinsurance ranging from 0% to 20%, subject to prior authorization. Medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueMedicare Premier (HMO), requiring referrals and prior authorization. Diagnostic tests range from a $0 to $50 copay with no coinsurance, lab services and X-rays have no copay, diagnostic radiological services start at a $0 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
BlueMedicare Premier (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueMedicare Premier (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice as cardiac rehabilitation (with a $25 copay), intensive cardiac (with a $50 copay), pulmonary (with a $20 copay), and SET for PAD (with a $20 copay) services are not covered. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
BlueMedicare Premier (HMO) covers skilled nursing facility (SNF) care with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a 3-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other Services are covered under the BlueMedicare Premier (HMO) plan, though in practice acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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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.
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