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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 Counties: Char., Collier, Lee, Manatee, Sarasota. 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 $4200.00 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. Under this plan, you will enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled through standard pharmacies or standard mail order. This cost-saving benefit applies to both 1-month and 3-month supplies of these low-tier medications. For higher-tier prescriptions, coverage is based on coinsurance for both standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers robust medical coverage with no copay for primary care visits and low copays ranging up to $45 for specialists, all with no coinsurance. For hospital stays, members pay no coinsurance, with inpatient care requiring a $310 daily copay for the first seven days and no copay thereafter. Outpatient services and emergency care are also covered with no coinsurance, featuring manageable copays such as a $150 copay for emergency room visits and no copay for home health services. This plan also includes valuable everyday benefits, offering routine dental, hearing, and vision exams with no copay or coinsurance, alongside a $225 annual allowance for eyewear. Skilled nursing facility care features no copay for the first 20 days, while diagnostic lab services and outpatient X-rays are also available with no copay. Additionally, members can access over-the-counter health items with no copay up to a $45 benefit allowance every three months.
Inpatient Hospital See details
BlueMedicare Premier (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $310 daily copay for days 1 to 7 and no copay for days 8 and beyond. Inpatient psychiatric care is also covered with no coinsurance at a $210 daily copay for days 1 to 7 and no copay for days 8 to 90, though additional psychiatric days, upgrades, 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 up to $235 for outpatient hospital services and a $150 copay per stay for observation services. Ambulatory surgical center services require a $185 copay, outpatient substance abuse sessions carry a $30 or $40 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization services are covered by BlueMedicare Premier (HMO) with a $50.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueMedicare Premier (HMO), with prior authorization required for all ambulance services. Ground ambulance services feature no copay up to a $320 copay with no coinsurance, while air ambulance services require a 20% coinsurance with no copay. For transportation services, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under BlueMedicare Premier (HMO) are covered with a $150 copay (waived if admitted to the hospital within 48 hours) and no coinsurance, while urgently needed services require a $65 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum benefit with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Premier (HMO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $45 copay and no coinsurance. Physical, occupational, and mental health therapies are covered with copays up to $40 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
BlueMedicare Premier (HMO) preventive services are partially covered with no copay and no coinsurance for covered services, including kidney disease education, diabetes self-management, and memory fitness. Several sub-services are not covered under this plan, such as annual physical exams, health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Hearing Services are covered by BlueMedicare Premier (HMO) with no deductible, no coinsurance, and no copay for exams and fitting evaluations, though a referral is required. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $350 to $1,825 for up to two aids per year, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BlueMedicare Premier (HMO) features partially covered vision services, offering one routine eye exam per year with no copay or coinsurance, though other eye exam services are not covered. Eyewear, including contacts, eyeglasses, and upgrades, is also covered with no copay, no coinsurance, and no deductible up to a $225 annual maximum.
Dental Services See details
Dental services are partially covered by BlueMedicare Premier (HMO), with Medicare-covered dental services requiring a $45 copay and no coinsurance, and other covered preventive and comprehensive services requiring no copay and no coinsurance. Sub-services not covered by the plan include other diagnostic dental services, adjunctive general services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
BlueMedicare Premier (HMO) covers home infusion bundled services, which require prior authorization and may involve step therapy. Under this benefit, Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, other Part B drugs feature no copay and 0% to 20% coinsurance, and chemotherapy 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
BlueMedicare Premier (HMO) covers medical equipment with no copays, though coinsurance and prior authorization requirements may apply. Durable medical equipment and prosthetics feature 0% to 20% coinsurance, while medical supplies and diabetic equipment are covered with no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Premier (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for these benefits. Members pay no coinsurance for diagnostic services, no copay for lab services or outpatient X-rays, a copay of $0 to $50 for diagnostic procedures, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the BlueMedicare Premier (HMO) plan with no copay and no coinsurance, though prior authorization is required for these services.
Cardiac Rehabilitation Services See details
BlueMedicare Premier (HMO) covers Cardiac Rehabilitation Services with no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization and referrals are required for any covered rehabilitation services.
Skilled Nursing Facility (SNF) See details
BlueMedicare Premier (HMO) covers skilled nursing facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
BlueMedicare Premier (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $45 every three months. Acupuncture, meal benefits, and dual eligible SNP 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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