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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 2026, 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 4 out of 5 stars in 2026.
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 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 $3300.00 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 features an annual drug deductible of $615. For initial coverage, members enjoy no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs. This no copay benefit applies to both 1-month and 3-month supplies filled at standard retail pharmacies or through standard mail order services. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance for standard pharmacy and mail-order fills. Additionally, Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Preferred (HMO) plan offers robust coverage with many essential services available at no cost to you. You will pay no copay and no coinsurance for primary care visits, home health services, and routine dental and vision exams. For other medical needs, specialist visits require a $25 copay, emergency room visits have a $150 copay, and inpatient hospital stays require a $210 daily copay for the first seven days before dropping to no copay. This plan also includes valuable supplemental benefits to help manage your everyday health expenses. You can take advantage of a $3,000 annual maximum for preventive and comprehensive dental care and a $225 annual allowance for eyewear, both with no copay. Additionally, the plan provides a $75 quarterly allowance for over-the-counter items with no copay, and skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
BlueMedicare Preferred (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $210 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 $350 daily copay for days 1 to 7 and no copay for days 8 to 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Preferred (HMO) covers outpatient hospital services with a $190 copay, observation services with a $150 copay, and ambulatory surgical center services with a $135 copay, all with no coinsurance. Outpatient substance abuse services feature no coinsurance with a $30 to $40 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
BlueMedicare Preferred (HMO) covers partial hospitalization services with a $50 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueMedicare Preferred (HMO), which offers ground ambulance services with a copay ranging from no copay to $375 plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay. Prior authorization is required for ambulance services, and transportation to health-related locations is not covered under this plan.
Emergency Services See details
BlueMedicare Preferred (HMO) covers emergency services with a $150 copay (waived if admitted within 48 hours) and urgently needed services with a $65 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum with a $150 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay with no coinsurance. Other covered services, including mental health, psychiatry, and physical therapy, have copays ranging from $0 to $55 and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
BlueMedicare Preferred (HMO) partially covers preventive services with no copay and no coinsurance for covered benefits like kidney disease education, diabetes self-management training, glaucoma screenings, and memory fitness. However, several sub-services, including annual physical exams, health education, and in-home safety assessments, are not covered.
Hearing Services See details
BlueMedicare Preferred (HMO) covers routine hearing exams and fitting evaluations annually with no copay or coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $350 to $1,825 and no coinsurance for up to two devices per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
BlueMedicare Preferred (HMO) partially covers vision services, offering one annual routine eye exam and eyewear—including lenses, frames, and contacts—with no copay, no coinsurance, and no deductible. Other eye exam services are not covered, a referral is required for exams, and eyewear is subject to a $225 annual maximum benefit.
Dental Services See details
BlueMedicare Preferred (HMO) provides partially covered dental services, featuring a $25 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other covered preventive and comprehensive services up to a $3,000 annual maximum. Sub-services that are not covered under this plan include other diagnostic dental services, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
BlueMedicare Preferred (HMO) covers home infusion bundled services with prior authorization, requiring no coinsurance to 20% coinsurance for Part B chemotherapy, radiation, and other drugs. Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while other Part B drugs have no copay.
Dialysis Services See details
Dialysis services are covered under the BlueMedicare Preferred (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Preferred (HMO) covers medical equipment with no copays, though durable medical equipment and prosthetic devices require a 20% coinsurance. Diabetic equipment, diabetic supplies, therapeutic shoes, and general medical supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueMedicare Preferred (HMO) with prior authorization and referrals required. Diagnostic services feature no coinsurance, with a $0 to $110 copay for procedures and no copay for labs, while radiological services require no copay for diagnostic scans and X-rays, but carry coinsurance for X-rays and a minimum 20% coinsurance for therapeutic treatments.
Home Health Services See details
BlueMedicare Preferred (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services under BlueMedicare Preferred (HMO) feature no coinsurance, and although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered. These non-covered services require prior authorization and referrals, with copays of $35 for cardiac and intensive cardiac rehab, and $20 for pulmonary and SET for PAD services.
Skilled Nursing Facility (SNF) See details
BlueMedicare Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, but a three-day prior inpatient hospital stay is not necessary for admission.
Other Services See details
Other Services are partially covered under BlueMedicare Preferred (HMO), which provides Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum of $75 every three months. Acupuncture, meal benefits, and other additional 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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