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True Blue Rx Extend (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx Extend (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on True Blue Rx Extend (HMO) in 2025, please refer to our full plan details page.
True Blue Rx Extend (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 Rx Extend (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 True Blue Rx Extend (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 Rx Extend (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 $100.00 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 $4200.00 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 True Blue Rx Extend (HMO) plan has a $100 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For generic drugs, you can expect to pay a $6 copay at a standard or mail-order pharmacy for preferred generics and a $47 copay for standard generics. Brand-name drugs have a 50% coinsurance, and non-preferred drugs have a 31% coinsurance. Specialty tier drugs have no copay.
Additional Benefits
The True Blue Rx Extend (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for hospital stays with copays, outpatient services, and emergency services. Additionally, the plan provides coverage for primary care, preventive services, and home health services with no copays. This plan also offers hearing, vision, and dental services, with varying copays for exams and hearing aids. Other benefits include coverage for medical equipment, home infusion, and dialysis services. The plan also provides coverage for OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits for the True Blue Rx Extend (HMO) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $225 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $225 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with copays ranging from $0-$150 for outpatient hospital services and a $150 copay for observation services. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have no copay for individual and group sessions. Outpatient blood services are also covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the True Blue Rx Extend (HMO) plan with a $25 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $200 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the True Blue Rx Extend (HMO) plan with a $100 copay, and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance, while Worldwide Emergency Services have no copay or coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (except Routine Care, which is not covered), Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $0-$20 copay, and Mental Health Specialty Services with a $0 copay for individual and group sessions. Other covered benefits include Other Health Care Professional services with a $0-$20 copay, Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $0-$20 copay, Additional Telehealth benefits with a $0-$25 copay, and Opioid Treatment Program Services with no copay.
Preventive Services See details
The True Blue Rx Extend (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, kidney disease education, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. The plan also covers a fitness benefit with no copay. However, in-home safety assessments, personal emergency response systems, and other services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids, with OTC hearing aids not covered. Hearing exams have a $25 copay, and routine hearing exams have no copay. Prescription hearing aids (all types) have a copay between $499 and $999, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The True Blue Rx Extend (HMO) plan offers vision services including eye exams with no copay, and eyewear. Eyewear includes contact lenses with a $0-$35 copay, eyeglasses (lenses and frames) with a $35 copay, and eyeglass lenses and frames are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $25 copay, and other dental services with no copay. This plan also covers oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable & fixed), implant services, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance of 0-20%, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services, and a coinsurance for Medicare-covered lab services. Diagnostic procedures/tests have a maximum copay of $30 and a coinsurance of up to 20%, while lab services have no copay. Radiological Services include coverage for diagnostic radiological services with a copay up to $150, therapeutic radiological services with a coinsurance of up to 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the True Blue Rx Extend (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 not covered by the True Blue Rx Extend (HMO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the True Blue Rx Extend (HMO) plan, but require prior authorization. For days 1-20 and days 56-100, there is no copay, but there is a $203 copay for days 21-55.
Other Services See details
The True Blue Rx Extend (HMO) plan covers Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $105 every three months. Acupuncture, meal benefits, and many other services are not covered.
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