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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 Brevard and St. Lucie 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 $3700.00 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. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a $0 copay for preferred generic drugs at standard and mail-order pharmacies. Standard generic drugs have a $20 copay, while preferred brand drugs have a $93 copay. Non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a copay, and outpatient services with varying copays. Emergency and urgent care services are covered with a copay, and ambulance services have a copay. This plan also includes coverage for primary care, mental health, and therapy services with copays. Additionally, you'll find benefits for vision, dental, and hearing services, along with coverage for home health and skilled nursing facilities. The plan includes other services like diagnostic and radiological services, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $175 copay for days 1-6, and no copay for days 7-90, with additional days 91-999 having no copay. Inpatient Hospital Psychiatric services have a $300 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services with BlueMedicare Premier (HMO) include outpatient hospital services with a copay between $0 and $125, observation services with a $140 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Premier (HMO) plan, and requires prior authorization. You will have a $20 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the BlueMedicare Premier (HMO) plan. Ground and air ambulance services have a $225 copay, and transportation services to a plan-approved health-related location have no copay for up to 30 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueMedicare Premier (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $10 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 and physician specialist services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $25 copay. Mental health and psychiatric services have a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $25. Other health care professional services have a copay between $0 and $20. Additional telehealth benefits, and opioid treatment program services have a $20 copay. However, 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 partially covered, but 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 and modifications, and counseling services are not covered. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with no copay, as well as coverage for routine hearing exams and fitting/evaluation for hearing aids, both with no copay. Prescription hearing aids are covered with a copay between $350 and $1825, but inner ear, outer ear, and over the ear hearing aids 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-$11, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, frames, and upgrades, have no copay, with a combined maximum plan benefit of $250 per year.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers dental services, including Medicare dental services with a $11 copay, and other dental services with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with no copay, while 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 under the BlueMedicare Premier (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Premier (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay, but has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, but have a 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 $100, while 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 covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
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. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueMedicare Premier (HMO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $45.00 every three months, and offers Nicotine Replacement Therapy (NRT) and Naloxone as an OTC benefit. 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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