A non-government entity
True Blue Valor (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Valor (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on True Blue Valor (HMO) in 2026, please refer to our full plan details page.
True Blue Valor (HMO) is a HMO plan offered by Gemstone Holdings, Inc. available for enrollment in 2025 to people living in Select Counties in Idaho. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that True Blue Valor (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about True Blue Valor (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 True Blue Valor (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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:
Sign up for True Blue Valor (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by True Blue Valor (HMO).
Additional Benefits
The True Blue Valor (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and many preventive services. For specialist visits, urgent care, and partial hospitalization, members pay a low $25 copay with no coinsurance. Inpatient hospital stays require no coinsurance and a $250 daily copay for the first five days, while emergency room visits carry a $100 copay that is waived if you are admitted. Most routine dental, vision, and hearing services are covered with low or no copays, including no copay for routine annual hearing exams and preventive dental care. Medical equipment and dialysis services require no copay but carry a 10% and 20% coinsurance respectively, while home health services feature no copay and no coinsurance. Skilled nursing facility stays are also highly affordable, requiring no copay for the first 20 days and days 56 through 100.
Inpatient Hospital See details
True Blue Valor (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $250 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by True Blue Valor (HMO) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Individual and group substance abuse sessions require a $25 copay, while outpatient hospital and observation services have copays ranging from $0 to $150.
Partial Hospitalization See details
True Blue Valor (HMO) covers partial hospitalization benefits with a $25 copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
True Blue Valor (HMO) covers Medicare-covered ground and air ambulance services with a $175 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
True Blue Valor (HMO) covers emergency services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
True Blue Valor (HMO) covers primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits, mental health, and psychiatric services require a $25 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $15 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
True Blue Valor (HMO) preventive services are partially covered with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, remote access technologies, and kidney disease education. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety, or counseling services.
Hearing Services See details
Hearing services are covered by True Blue Valor (HMO) with a $20 copay and no coinsurance for exams (referral required), though routine annual exams have no copay. Prescription hearing aids are partially covered with no coinsurance and copayments ranging from $499 to $999 for up to two devices per year, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
True Blue Valor (HMO) partially covers vision services with no deductible and no coinsurance, though prior authorization and referrals are required. One routine eye exam is covered annually with a $20 copay, eyeglasses (lenses and frames) are covered with a $35 copay up to $50 every two years, and contact lenses are covered with a copay ranging from no copay to $35 up to $100 every two years, while other eye exam services, separate eyeglass lenses, and separate eyeglass frames are not covered.
Dental Services See details
True Blue Valor (HMO) offers partially covered dental services, with no coverage for other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics. Medicare dental services require a $25 copay and no coinsurance, while most preventive and comprehensive services feature no copay and no coinsurance, except for implants and fixed prosthodontics which require a $300 copay and no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by True Blue Valor (HMO) with no copay, with associated Part B chemotherapy, radiation, and other drugs requiring no copay and no coinsurance to 10% coinsurance. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance to 10% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the True Blue Valor (HMO) plan with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
True Blue Valor (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes, with no copay and a 10% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for DME and prosthetics.
Diagnostic and Radiological Services See details
True Blue Valor (HMO) covers diagnostic and radiological services with no coinsurance, although referrals and prior authorizations are required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests require a copay of $0 to $30, and diagnostic or therapeutic radiological services have copays starting at $0.
Home Health Services See details
Home Health Services are covered by True Blue Valor (HMO) with no copay and no coinsurance, though a referral is required to receive care.
Cardiac Rehabilitation Services See details
True Blue Valor (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though a referral is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
True Blue Valor (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 56 through 100, a $218 daily copay for days 21 through 55, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
True Blue Valor (HMO) partially covers other services, offering convenience care with no copay and no coinsurance up to a $2,500 annual limit, though prior authorization is required. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved