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FHCP Medicare Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for FHCP Medicare Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on FHCP Medicare Classic (HMO) in 2026, please refer to our full plan details page.
FHCP Medicare Classic (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Counties: BRE, FLA, SEM, SJO and VOL. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that FHCP Medicare Classic (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 FHCP Medicare Classic (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 FHCP Medicare Classic (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 $9250.00 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 FHCP Medicare Classic (HMO) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through standard mail order for multi-month supplies, while standard pharmacies charge a $17 copay for a one-month supply. For Tier 2 generic drugs, you will pay a $10 copay for a one-month supply at a preferred pharmacy or a $20 copay at a standard pharmacy. Tier 3 preferred brand drugs require a $44 copay for a one-month supply at preferred pharmacies, compared to a $47 copay at standard pharmacies. Higher-tier medications, including Tier 4 non-preferred drugs and Tier 5 specialty drugs, incur a 25% coinsurance across both preferred and standard pharmacies. Additionally, Tier 6 vaccines are covered with no copay for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The FHCP Medicare Classic (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, home health services, and covered preventive care. For hospital stays, members pay a $480 copay for the first five days of acute inpatient care and no copay for subsequent days, while outpatient hospital services require a $480 copay. Specialist visits remain affordable with copays ranging from $5 to $50 and no coinsurance. This plan also includes valuable dental, vision, and hearing benefits, offering routine exams and cleanings with no copay, alongside allowances for glasses and hearing aids. Skilled nursing facility care is covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100. Please note that some services, such as acupuncture, over-the-counter items, meals, and transportation, are not covered under this plan.
Inpatient Hospital See details
FHCP Medicare Classic (HMO) offers partially covered inpatient hospital services with no coinsurance, though prior authorization and referrals are required. Acute stays require a $480 copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $480 copay for days 1 through 4 and no copay for days 5 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
FHCP Medicare Classic (HMO) covers outpatient services with no coinsurance, featuring a $480 copay for outpatient hospital and observation services and a $380 copay for ambulatory surgical center services. Outpatient substance abuse services require a $50 copay, while outpatient blood services are covered with no copay.
Partial Hospitalization See details
FHCP Medicare Classic (HMO) covers partial hospitalization services with a $100 copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under FHCP Medicare Classic (HMO) cover ground ambulance services with a $265 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
FHCP Medicare Classic (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $25,000 maximum with no coinsurance and copays ranging from $40 to $265.
Primary Care See details
FHCP Medicare Classic (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits range from a $5 to $50 copay with no coinsurance. Physical, occupational, and speech therapy require a $25 copay with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
FHCP Medicare Classic (HMO) offers partially covered preventive services with no copay and no coinsurance for covered care, such as Medicare-covered zero-dollar services, kidney disease education, and health education. However, several services are not covered, including annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
FHCP Medicare Classic (HMO) covers Medicare-covered hearing exams with a $45 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $300 maximum per ear yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
FHCP Medicare Classic (HMO) offers partially covered vision services with no deductible and no coinsurance, featuring one annual routine eye exam with no copay and one pair of eyeglasses every two years up to $180 with no copay. Other eye exams may require a copay up to $50, while contact lenses, individual lenses or frames, and upgrades are not covered.
Dental Services See details
FHCP Medicare Classic (HMO) dental services are partially covered, offering Medicare-covered dental care for a $50 copay and no coinsurance, alongside preventive exams, cleanings, and x-rays for no copay and no coinsurance. Removable prosthodontics and oral surgery are also covered with no copay and no coinsurance, while fluoride, restorative, endodontics, periodontics, fixed prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
FHCP Medicare Classic (HMO) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Covered Medicare Part B drugs—including chemotherapy, radiation, and other drugs—have coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
FHCP Medicare Classic (HMO) covers dialysis services with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
FHCP Medicare Classic (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with no copay and a 20% coinsurance for most covered items. Diabetic supplies range from no coinsurance to 20% coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
FHCP Medicare Classic (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for all services. Lab services feature no copay or coinsurance, diagnostic procedures have no coinsurance and copays ranging from $0 to $480, and radiological services require copays starting at $10 or a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under FHCP Medicare Classic (HMO) with no copay and no coinsurance, although both prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
FHCP Medicare Classic (HMO) provides Cardiac Rehabilitation Services with no coinsurance, but in practice some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by FHCP Medicare Classic (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Other Services are not covered under the FHCP Medicare Classic (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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