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BlueMedicare Preferred (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Preferred (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Preferred (HMO) in 2025, please refer to our full plan details page.
BlueMedicare Preferred (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Hillsborough and Polk Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare Preferred (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 Preferred (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 Preferred (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 $2100.00 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 Preferred (HMO) plan has an "Enhanced Alternative" drug benefit type. There is no deductible for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy type. For example, you will have no copay for preferred generic drugs at a standard pharmacy, or a $25 copay for standard generic drugs. After your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The BlueMedicare Preferred (HMO) plan offers a variety of benefits with varying cost-sharing. Hospital stays have copays, while outpatient services have copays ranging from $0 to $140. The plan also covers ambulance services, emergency services, and many primary care services with no copay. Additional benefits include hearing, vision, and dental services, with copays for exams and hearing aids. The plan also covers home health services, skilled nursing facilities, and provides an allowance for over-the-counter items. Diagnostic and radiological services are covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you have a $120 copay for days 1-6, and no copay for days 7-90, with additional days 91-999 having no copay; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, you have a $300 copay for days 1-5, and no copay for days 6-90; however, 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 Outpatient Hospital Services with a copay between $0 and $90, Observation Services with a $140 copay, Ambulatory Surgical Center (ASC) 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 Preferred (HMO) plan, but requires prior authorization. You will have a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by the BlueMedicare Preferred (HMO) plan. Ground and air ambulance services have a $225 copay, while Transportation Services to a plan-approved health-related location have no copay, with a limit of 30 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Coverage, are covered by the BlueMedicare Preferred (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $20 copay; Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Preferred (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay between $0 and $5, and Mental Health Specialty Services with a $20 copay. The plan also covers Other Health Care Professional services with a copay between $0 and $20, Psychiatric Services with a $20 copay, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $30, and Additional Telehealth Benefits with a copay between $0 and $30. Opioid Treatment Program Services are covered with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The BlueMedicare Preferred (HMO) plan covers preventive services, with no copay for Medicare-covered services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, Health Education, In-Home Safety Assessment, Personal Emergency Response System (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 Benefit, 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.
Hearing Services See details
The BlueMedicare Preferred (HMO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $350 and $1825, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BlueMedicare Preferred (HMO) plan covers vision services, including eye exams with a copay between $0 and $5, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage amount of $300 per year.
Dental Services See details
The BlueMedicare Preferred (HMO) plan covers Medicare dental services with a $5 copay and requires prior authorization and a doctor referral. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Adjunctive general services, maxillofacial prosthetics, implant services, 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% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, with no copay.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Preferred (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has no copay and a coinsurance between 0% and 20%, while 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, including all diagnostic and radiological services, are covered with a doctor referral and prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $110, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $0 and $110, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Preferred (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 by the BlueMedicare Preferred (HMO) plan, but all of the sub-services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, 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
Other Services offered by the BlueMedicare Preferred (HMO) plan include a $189 allowance every three months for over-the-counter items, including nicotine replacement therapy and naloxone, but acupuncture, meal benefits, 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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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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