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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 Lake, Marion, & Sumter 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 $2700.00 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 prescription 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 for both 1-month and 3-month supplies at standard pharmacies and standard mail order. This ensures that many essential and everyday medications are available at no cost to you. For higher-tier medications, your costs are determined by coinsurance at standard pharmacies and standard mail order. 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. Tier 5 specialty drugs are limited to a 1-month supply under these standard options.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers robust medical coverage with low out-of-pocket costs, featuring no copays for primary care visits and low copays ranging from no copay to $35 for specialists. Inpatient hospital stays require a $175 daily copay for the first seven days and no copay thereafter, while outpatient hospital services feature no coinsurance and copays ranging from no copay up to $125. Additionally, standard preventive care, home health services, and laboratory tests are covered with no copays or coinsurance. This plan also provides supplemental benefits, including routine dental and hearing services with no copays or coinsurance up to generous annual limits. Vision care is covered with no copays for eyewear up to a $225 annual maximum, and members receive an $85 over-the-counter allowance every three months with no copay. Emergency room visits carry a flat $150 copay with no coinsurance, which is waived if you are admitted within 48 hours.
Inpatient Hospital See details
BlueMedicare Premier (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a copay of $175 per day for days 1 through 7 and no copay for days 8 through 90. While unlimited additional acute care days are covered with no copay, 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, featuring a $0 to $125 copay for outpatient hospital services, a $150 copay per stay for observation services, and no copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are provided with no copay, coinsurance, or deductible.
Partial Hospitalization See details
BlueMedicare Premier (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
BlueMedicare Premier (HMO) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $290 plus coinsurance for ground services, and a 20% coinsurance plus a copay for air services. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueMedicare Premier (HMO) covers emergency services with a $150 copay (waived if admitted within 48 hours) and urgently needed services with a $65 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Premier (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Covered therapy, mental health, and psychiatric services have copays ranging from $0 to $40 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under BlueMedicare Premier (HMO) with no copays and no coinsurance for Medicare-covered zero-dollar preventive services, kidney disease education, select screenings, and memory fitness. However, several benefits are not covered, including annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
BlueMedicare Premier (HMO) covers routine hearing exams, fittings, and prescription hearing aids with no copays, no coinsurance, and no deductibles, though a referral is required. This partially covered benefit provides up to $1,000 per ear annually for up to two prescription devices, but does not cover OTC hearing aids or inner ear, outer ear, and over-the-ear prescription hearing aid types.
Vision Services See details
BlueMedicare Premier (HMO) partially covers vision services, as other eye exam services are not covered. Routine eye exams are covered with no coinsurance and a $0 to $35 copay (referral required), while contacts, lenses, frames, and upgrades are covered with no copay and no coinsurance up to a $225 annual maximum.
Dental Services See details
BlueMedicare Premier (HMO) provides partially covered dental services with a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive services up to a $3,500 annual maximum. However, other diagnostic dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
BlueMedicare Premier (HMO) covers Home Infusion bundled Services with prior authorization and step therapy requirements. Under this benefit, Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, other Part B drugs have no copay and 0% to 20% coinsurance, and chemotherapy or radiation drugs require a copay and 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
Medical equipment is covered by BlueMedicare Premier (HMO) with no copays, though prior authorization is required for some items. Durable medical equipment and prosthetic devices have 0% to 20% coinsurance, while diabetic supplies, therapeutic shoes, and medical supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueMedicare Premier (HMO), with prior authorization and referrals required for all care. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests carry a copay between $0 and $50 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by BlueMedicare Premier (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueMedicare Premier (HMO) cardiac rehabilitation services feature no coinsurance, but only some services are covered. Specifically, standard cardiac rehabilitation (with a $25 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $20 copay), and supervised exercise therapy for PAD (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueMedicare Premier (HMO) with no coinsurance and do not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BlueMedicare Premier (HMO) partially covers other services, which includes an over-the-counter (OTC) benefit with no copay and no coinsurance up to $85 every three months. However, acupuncture, meal benefits, and other additional services are not covered under this plan.
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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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