A non-government entity
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:
Sign up for True Blue Rx Extend (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
The True Blue Rx Extend (HMO) plan has a $100 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. In the initial coverage phase, generic drugs have a copay of $6 or $47, depending on the tier and pharmacy. Brand name drugs have 50% coinsurance, while non-preferred drugs have 31% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The True Blue Rx Extend (HMO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and ambulance services with a $200 copay. Emergency services have copays ranging from $0 to $100, and primary care services often have no copay. Preventive services, hearing exams, and vision services are also included, with specific copays and coverage details for each. Additional benefits include dental coverage, home infusion services with copays and coinsurance, and dialysis services with a 20% coinsurance. The plan also covers medical equipment, diagnostic services, and home health services. The plan offers additional benefits such as OTC items, with a maximum benefit, and other services with Prior Authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay of $225 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 stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $150, Observation Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with no copay, and Outpatient Blood Services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the True Blue Rx Extend (HMO) plan, with a $25 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the True Blue Rx Extend (HMO) plan. Both ground and air ambulance services have a $200 copay with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $100 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The True Blue Rx Extend (HMO) plan covers primary care services, including primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $20 copay, while physician specialist services, mental health specialty services, and physical therapy and speech-language pathology services have a copay between $0 and $20. Additional telehealth benefits are covered with a copay between $0 and $25, and opioid treatment program services have no copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The True Blue Rx Extend (HMO) plan covers preventive services, including an annual physical exam, Health Education, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan's fitness benefit is covered with no copay. However, other services such as In-Home Safety Assessment, Personal Emergency Response System, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams have no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $999, while inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered with no copay. Eyewear includes contact lenses with a copay between $0-$35, and eyeglasses with a $35 copay. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services include Medicare dental services with a $25 copay, and other dental services with no copay. Orthodontic services have a maximum benefit of $500 per year, and there is a $1650 maximum benefit for orthodontic services. Oral exams are limited to two per calendar year, and dental x-rays are limited to 1 bite wing every year and 1 full mouth x-ray every three years. Fluoride treatment is covered once per year. Maxillofacial prosthetics and orthodontics are not covered. Implant services and prosthodontics, fixed have a $300 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the True Blue Rx Extend (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, but DME for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered supplies, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the True Blue Rx Extend (HMO) plan. Diagnostic Procedures/Tests have a copay of up to $30 and a coinsurance of up to 20%, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $150, Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have 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. However, 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the True Blue Rx Extend (HMO) plan, but require prior authorization. For days 1-20 and 56-100, there is no copay, and for days 21-55, the copay is $203. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The True Blue Rx Extend (HMO) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items, with a maximum benefit of $105 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, Meal Benefit, 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 with a maximum amount of $2500 every year and requires Prior Authorization.
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