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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 Counties: Char., Collier, Lee, Manatee, Sarasota. 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 $3400.00 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 an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you will have no copay for preferred generic drugs at a standard or mail pharmacy. For standard generic drugs, you will pay a $30 copay, and for preferred brand drugs, you will pay a $90 copay. Non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have copays ranging from $0 to $135. Emergency services have a $140 copay, and primary care visits are covered with no copay. The plan includes coverage for hearing and vision services, with no copays for routine exams and eyewear up to a certain amount. Dental services are covered with no copay for some services and a $20 copay for Medicare dental services. Additional benefits include ambulance services, home health, and some medical equipment.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $160 copay for days 1-7, and no copay for days 8-90; Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. For Inpatient Hospital Psychiatric, you will pay a $160 copay for days 1-9, and no copay for days 10-90. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $135, observation services have a $140 copay, ambulatory surgical center services have no copay, individual and group sessions for outpatient substance abuse have a $20 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance. Ground and Air Ambulance Services have a $225 copay, while Transportation Services to a plan-approved health-related location has no copay and covers up to 30 one-way trips per year. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the BlueMedicare Premier (HMO) plan, with a $140 copay for emergency services and a $10 copay for urgently needed services, while worldwide emergency coverage and worldwide urgent coverage have a $140 copay, and worldwide emergency transportation is not covered. The plan also includes worldwide emergency services with a maximum benefit of $25,000.
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, physician specialist services with a $0-$20 copay, mental health specialty services with a $20 copay, other health care professional services with a $0-$20 copay, psychiatric services with a $20 copay, physical therapy and speech-language pathology services with a $0-$20 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, while additional preventive services may have a copay. The plan does not cover annual physical exams, and some additional preventive services are not covered.
Hearing Services See details
The BlueMedicare Premier (HMO) plan covers hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $350 and $1825, 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
Vision services, including services not usually covered by Medicare, are covered by the BlueMedicare Premier (HMO) plan. Eye exams have a copay between $0 and $20, and routine eye exams have no copay, but are limited to one exam per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum benefit of $250 per year.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers Medicare Dental Services with a $20 copay, and other dental services with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay. Adjunctive general services, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Insulin has a $35 copay with a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20% and no copay.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Premier (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a 0-20% coinsurance, but Durable Medical Equipment 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
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $50, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $100, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Premier (HMO) plan with no copay and no coinsurance. However, 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. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
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, and for days 21-100, the copay is $214.
Other Services See details
The BlueMedicare Premier (HMO) plan covers Over-the-Counter (OTC) items, with a maximum benefit coverage of $48 every three months, including nicotine replacement therapy 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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