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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 Brevard and St. Lucie 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 $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 prescription drug deductible of $615. Beneficiaries can enjoy significant savings on several medication tiers, as there is no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This no-copay benefit applies to both 1-month and 3-month supplies for these tiers. For higher-tier medications, cost-sharing is structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty tier drugs require a 25% coinsurance for a 1-month supply. These coinsurance rates apply to both standard pharmacy and standard mail order options.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers robust essential coverage, featuring no copay for primary care doctor visits, home health services, and covered preventive care. Specialist visits require a $45 copay, while inpatient hospital stays incur a daily copay of $325 for acute stays or $350 for psychiatric stays during the first seven days. Emergency room visits carry a $150 copay that is waived upon admission, and urgent care is available for a $65 copay. This plan also includes key supplemental benefits, such as routine dental, vision, and hearing exams with no copay, alongside a $225 annual allowance for eyewear. Skilled nursing facility stays feature no copay for the first 20 days, and members receive a $30 quarterly allowance with no copay for over-the-counter items. Diagnostic lab work and outpatient X-rays are covered with no copay, while durable medical equipment requires zero to 20 percent coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by BlueMedicare Premier (HMO) with no coinsurance, requiring a $325 daily copay for days 1-7 for acute stays and a $350 daily copay for days 1-7 for psychiatric stays, with no copay for subsequent days. Prior authorization is required, and 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, including outpatient hospital services with a $0 to $225 copay, observation services with a $150 copay per stay, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by BlueMedicare Premier (HMO) with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under BlueMedicare Premier (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require no copay to a $345 copay and coinsurance, while air ambulance services require 20% coinsurance and a copay, with prior authorization required for all ambulance services.
Emergency Services See details
BlueMedicare Premier (HMO) covers emergency services with a $150 copay—which is waived if you are admitted to the hospital within 48 hours—and no coinsurance, and urgently needed services with a $65 copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum benefit with a $150 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Premier (HMO) offers primary care doctor visits with no copay and no coinsurance, and specialist visits for a $45 copay and no coinsurance. Other covered services like physical therapy, mental health, and telehealth require copays ranging from $0 to $65 with no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are partially covered by BlueMedicare Premier (HMO) with no copay and no coinsurance for covered benefits like kidney disease education, memory fitness, and diabetes self-management. However, several sub-services are not covered under this plan, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
BlueMedicare Premier (HMO) offers partially covered hearing services with no deductibles and no coinsurance, featuring a $45 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids require a copay between $350 and $1,825, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Premier (HMO), which excludes other eye exam services but offers one routine eye exam per year with no copay and no coinsurance. Covered eyewear, including contacts and eyeglasses, also features no copay and no coinsurance up to a combined maximum plan benefit of $225 per year.
Dental Services See details
BlueMedicare Premier (HMO) provides partially covered dental services with a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive and comprehensive services. Sub-services not covered under this 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 with prior authorization, featuring a 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Part B insulin is covered with a $35 copay and 0% to 20% coinsurance, while other Part B drugs require no copay.
Dialysis Services See details
Dialysis services are covered under BlueMedicare Premier (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Premier (HMO) covers medical equipment with no copays, though prior authorization is required for durable medical equipment and prosthetics. Durable medical equipment has a coinsurance of 0% to 20%, prosthetic devices have a 20% coinsurance, and medical and diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Premier (HMO) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic tests with a copay of $0 to $50. Radiological services are also covered, featuring no copay for outpatient X-rays, a minimum $0 copay for diagnostic radiology, and a 20% minimum coinsurance for therapeutic radiology, with both benefits requiring referrals and prior authorization.
Home Health Services See details
Home health services are fully covered under the BlueMedicare Premier (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueMedicare Premier (HMO) with no coinsurance, but in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. These non-covered sub-services require referrals and prior authorization, with copays ranging from $20 to $50.
Skilled Nursing Facility (SNF) See details
BlueMedicare Premier (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BlueMedicare Premier (HMO) partially covers other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $30 every three months. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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Every year, Medicare evaluates plans based on a 5-star rating system.
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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