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True Blue Rx Essentials (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx Essentials (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 Essentials (HMO) in 2025, please refer to our full plan details page.
True Blue Rx Essentials (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 Essentials (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 Essentials (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 Essentials (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. Additionally, this plan comes with a Part B Premium reduction of $17.00. You must continue to pay paying your reduced 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 $275.00 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 $6000.00 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 Essentials (HMO) plan has a $275 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you may pay a $15 copay for preferred generic drugs at a standard or mail-order pharmacy. For specialty tier drugs, you will have no copay.
Additional Benefits
The True Blue Rx Essentials (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $325 copay for the first four days and no copay thereafter. Outpatient services, primary care, preventive services, and home health services are also covered with varying copays. The plan also provides coverage for emergency services, hearing and vision exams, dental, and home infusion services. This plan includes coverage for ambulance services, partial hospitalization, skilled nursing, and dialysis. It also covers medical equipment and a variety of diagnostic and radiological services. However, some services like acupuncture, over-the-counter items, and certain other services are not covered.
Inpatient Hospital See details
The True Blue Rx Essentials (HMO) plan covers inpatient hospital stays, including services not usually covered by Medicare plans, with a $325 copay for days 1-4, and no copay for days 5-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered. Inpatient hospital psychiatric services are also covered, with a $325 copay for days 1-4, and no copay for days 5-90, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $375, observation services with a $375 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services. The plan waives the three-pint deductible for blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the True Blue Rx Essentials (HMO) plan, but requires prior authorization. The plan has a $50 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the True Blue Rx Essentials (HMO) plan. Ground and Air Ambulance Services have a $265 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the True Blue Rx Essentials (HMO) plan with a $100 copay, and no coinsurance. Urgently Needed Services have a $40 copay, and no coinsurance. Worldwide Emergency Services are covered, with no copay or coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The True Blue Rx Essentials (HMO) plan covers primary care physician services with a copay between $0 and $10, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. This plan also covers physician specialist services with a copay between $0 and $50, and mental health specialty services and psychiatric services with a $40 copay for both individual and group sessions. Physical therapy and speech-language pathology services are covered with a copay between $0 and $30, and additional telehealth benefits are covered with a copay between $0 and $50. Opioid Treatment Program Services have no copay.
Preventive Services See details
The True Blue Rx Essentials (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education, and other preventive services. Additional preventive services may have a copay, and Fitness Benefit, including Memory Fitness, has no copay.
Hearing Services See details
Hearing exams are covered with a $50 copay, and fitting/evaluation for hearing aids are covered. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, but routine eye exams are offered as an optional, supplemental benefit. Eyewear is partially covered; contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $50 copay for Medicare Dental Services and a $20 copay for other dental services. The plan has a maximum benefit coverage of $500 per year. Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment are covered, but Orthodontic Services, Restorative Services, and other sub-services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the True Blue Rx Essentials (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. Durable Medical Equipment has a coinsurance between 0% and 20%, and Prosthetic Devices have a coinsurance between 0% and 20%; 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, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a maximum copay of $30, and no coinsurance, while lab services have a $20 copay. Diagnostic radiological services have a maximum copay of $250, and therapeutic radiological services have a 20% coinsurance. Outpatient X-Ray services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the True Blue Rx Essentials (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 covered by the True Blue Rx Essentials (HMO) plan, but the plan does not cover any of the sub-services. There is a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the True Blue Rx Essentials (HMO) plan. There is no copay for days 1-20, a $203 copay for days 21-55, and no copay for days 56-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the True Blue Rx Essentials (HMO) plan are not covered, including acupuncture, over-the-counter items, 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. Other 1 benefits are covered with prior authorization, including convenience care up to $3,000 per year.
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