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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 2025, 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 2025.
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)
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Drug Coverage
Prescription drugs are not covered by True Blue Valor (HMO).
Additional Benefits
The True Blue Valor (HMO) plan offers a range of benefits with varying costs. For hospital stays, there's a $100 copay for the first five days, then no copay for the remainder, and outpatient services have copays between $0 and $150. Emergency services have a $100 copay, and primary care visits are covered with no copay, while specialist visits cost $25. This plan also covers preventive services with no copay, and offers hearing and vision benefits, including hearing exams with a $25 copay and eyewear with no copay. Dental services have a $25 copay for Medicare-covered services, and other services like home health and skilled nursing facilities are covered with no copay or specific copays, respectively. There's also coverage for ambulance, prescription drugs, and medical equipment, with varying copays and coinsurance, and an OTC allowance of $75 every three months.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $100 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $150, observation services with a $150 copay, Ambulatory Surgical Center (ASC) services with no copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $25 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by True Blue Valor (HMO). Both ground and air ambulance services have a $175 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the True Blue Valor (HMO) plan with a $100 copay, and no coinsurance. Urgently Needed Services have a $25 copay, and no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay and no coinsurance.
Primary Care See details
The True Blue Valor (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $15 copay. Physician specialist services have a $25 copay, while mental health and psychiatric services have a $25 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $15 copay, and additional telehealth benefits have a copay between $0 and $25. Opioid treatment program services are covered with no copay.
Preventive Services See details
Preventive Services are covered by the True Blue Valor (HMO) plan, including Medicare-covered preventive services, annual physical exams, health education, kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services may have a copay, and some services such as in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services include hearing exams, with a $25 copay, and prescription hearing aids, with a copay between $499 and $999 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids. Routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have no copay, and routine eye exams have a $20 copay. Eyewear has no copay for eyewear, but contact lenses have a copay between $0 and $35, and eyeglasses have a $35 copay. Eyeglass lenses and frames are not covered.
Dental Services See details
The True Blue Valor (HMO) plan covers Medicare Dental Services with a $25 copay, and other dental services with no copay. This plan also covers some additional dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and implant services, though some require prior authorization and have copays. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 10%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 10%.
Dialysis Services See details
Dialysis Services are covered under the True Blue Valor (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 10% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medicare-covered Prosthetic Devices, and Medical Supplies have a 10% coinsurance, while Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, while Therapeutic Radiological Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the True Blue Valor (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 generally covered, but the plan does not cover any of the sub-services. The copay for these services is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the True Blue Valor (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 56-100, but there is a $203 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "True Blue Valor (HMO)" plan covers Over-the-Counter (OTC) items with a maximum benefit of $75 every three months, including nicotine replacement therapy and Naloxone. 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. Other 1 benefits are covered, but require prior authorization with a maximum benefit of $2500 every year.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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