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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 Lake, Marion, & Sumter 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 $2400.00 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. In the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs at standard or mail order pharmacies. For standard generic drugs, the copay is $35.00, and for preferred brand drugs the copay is $93.00. Non-preferred drugs have 33% coinsurance. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with copays, and coverage for emergency services. You'll find no copays for many services like primary care, preventive services, hearing exams, vision eyewear, and home health services. This plan also covers dental services, home infusion, and medical equipment, with varying copays or coinsurance depending on the service. Additionally, the plan provides coverage for certain diagnostic and radiological services, with copays, and offers an Over-the-Counter (OTC) allowance.
Inpatient Hospital See details
Inpatient Hospital coverage under the BlueMedicare Premier (HMO) plan includes acute and psychiatric care. For acute care, you'll pay a $115 copay for days 1-6 and no copay for days 7-90, while additional days have no copay. For psychiatric care, there is a $135 copay for days 1-9 and no copay for days 10-90. Non-Medicare-covered stays and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $85, Observation Services with a $140 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, as well as Outpatient Blood Services with no copay. The plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Premier (HMO) plan, but requires prior authorization. You will have a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by BlueMedicare Premier (HMO). Ground and air ambulance services each have a $225 copay, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered under the BlueMedicare Premier (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services has a $35 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Premier (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, and Physician Specialist Services with a $0-$15 copay. Mental Health Specialty Services, including individual and group sessions, and Psychiatric Services, including individual and group sessions, each have a $20 copay. Other Health Care Professional services have a $0-$20 copay, and Physical Therapy and Speech-Language Pathology Services have a $0-$20 copay. Additional Telehealth Benefits have a $0-$35 copay, and Opioid Treatment Program Services have a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The BlueMedicare Premier (HMO) plan covers preventive services, including Medicare-covered services with no copay. Additional preventive services are covered with no copay for services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, health education, in-home safety assessments, personal emergency response systems (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 benefits, home-based palliative care, in-home support services, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, modifications, and counseling services are not covered.
Hearing Services See details
The BlueMedicare Premier (HMO) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids (all types) are covered with no copay, up to a maximum of $1000 per ear every year, 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
The BlueMedicare Premier (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0 to $15, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, has no copay, with a combined maximum plan benefit of $300 per year.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers Medicare Dental Services for a $15 copay and other dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontics, Maxillofacial Prosthetics, and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance.
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 Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and 0-20% coinsurance, while DME for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have no coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The BlueMedicare Premier (HMO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $50, and lab services with no copay. Diagnostic radiological services have a copay of at most $85, 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. Prior authorization and a doctor 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, while days 21-100 have a $214 copay.
Other Services See details
Other Services with the BlueMedicare Premier (HMO) plan covers Over-the-Counter (OTC) Items with a maximum plan benefit coverage amount of $133.00 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone. Acupuncture, Meal Benefit, 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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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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