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True Blue Rx Gem (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx Gem (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 Gem (HMO) in 2025, please refer to our full plan details page.
True Blue Rx Gem (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 Gem (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 Gem (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 Gem (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.00. 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 $175.00 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 $5500.00 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 Gem (HMO) plan has a $175 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For a 30-day supply, you will pay $10 for preferred and standard generic drugs when using standard or mail order pharmacies. For preferred and standard brand drugs, you will pay 50% coinsurance. For non-preferred drugs, you will pay 31% coinsurance, and there is no copay for specialty tier drugs.
Additional Benefits
The True Blue Rx Gem (HMO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a $360 copay for the first five days, with no copay for days 6-90. The plan also covers outpatient services, including primary care with no copay and specialist visits with a copay. Additional benefits include coverage for hearing and vision services. Hearing exams have a $40 copay, and prescription hearing aids have a copay between $499 and $999. Vision services offer eye exams with no copay, and eyeglasses have a $35 copay. The plan also includes dental services, with a $40 copay for Medicare dental services.
Inpatient Hospital See details
Inpatient Hospital coverage under the True Blue Rx Gem (HMO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric benefits, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $360 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will also pay a $360 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services for the True Blue Rx Gem (HMO) plan include coverage for all outpatient hospital services, with copays ranging from $0 to $300, and observation services with a $300 copay. Ambulatory Surgical Center services have no copay, and outpatient substance abuse services have a $20 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered under the True Blue Rx Gem (HMO) plan with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the True Blue Rx Gem (HMO) plan. Medicare-covered ground and air ambulance services have a $265 copay, and there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the True Blue Rx Gem (HMO) plan. 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 Gem (HMO) plan covers primary care physician services and specialist services with a copay of $0-$10 and $0-$40, respectively. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay. The plan also covers mental health and psychiatric services, with individual and group sessions having a $20 and $20-40 copay, respectively. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a $0-$40 copay. Opioid treatment program services have no copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Additional preventive services have a copay, and some services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing Services are covered by the True Blue Rx Gem (HMO) plan, including hearing exams with a $40 copay. Prescription hearing aids are partially covered, with a copay between $499 and $999 for all types of prescription hearing aids, but not for inner ear, outer ear, or over the ear hearing aids.
Vision Services See details
Vision Services includes eye exams and eyewear. Eye exams have no copay, while routine eye exams have a $20 copay. Eyewear has no copay, but contact lenses have a copay between $0 and $35, and eyeglasses have a $35 copay. Eyeglass lenses and frames, as well as eyeglass frames, are not covered.
Dental Services See details
The True Blue Rx Gem (HMO) plan covers dental services, with a $40 copay for Medicare dental services and no copay for other dental services, up to a $500 annual maximum. The plan covers oral exams, dental x-rays, cleaning, fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, but does not cover maxillofacial prosthetics or orthodontics. Implant services and prosthodontics (fixed) have a $300 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the True Blue Rx Gem (HMO) plan, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the True Blue Rx Gem (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered under the True Blue Rx Gem (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and authorization is required. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no copay and 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 Gem (HMO) plan. Diagnostic Procedures/Tests have a copay of up to $30 and a coinsurance of at most 20%, while Lab Services have a $10 copay. Diagnostic Radiological Services have a copay of up to $200, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the True Blue Rx Gem (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 Gem (HMO) plan. The plan states that 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 Gem (HMO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-55, the copay is $203.00, and for days 56-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum plan benefit of $70.00 every three months. 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.
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