A non-government entity
True Blue Rx Option II (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx Option II (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 Option II (HMO) in 2025, please refer to our full plan details page.
True Blue Rx Option II (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 Option II (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 Option II (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 Option II (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $130.00. 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 $250.00 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 $6400.00 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 Option II (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 Option II (HMO) plan has a $250 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, Tier 1 (Preferred Generic) drugs have a $15 copay at a standard pharmacy or mail order. For Tier 5 (Specialty Tier) drugs, you will have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The True Blue Rx Option II (HMO) plan offers coverage for a variety of services. Inpatient hospital stays have a copay, while outpatient services have varying copays. Emergency services and primary care visits have copays, and preventive services are covered with no copay. This plan also includes benefits for hearing, vision, and dental services, with copays and coinsurance applying to some services. Additional benefits include coverage for ambulance services, home health, and medical equipment. Dialysis services have a 20% coinsurance, and the plan also offers over-the-counter benefits and convenience care.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $325 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 stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$325, Observation Services have a copay of $325, and Ambulatory Surgical Center Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the True Blue Rx Option II (HMO) plan with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the True Blue Rx Option II (HMO) plan, but require prior authorization. Both ground and air ambulance services have a $300 copay with no coinsurance, while 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 by the True Blue Rx Option II (HMO) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $40 copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The True Blue Rx Option II (HMO) plan covers primary care physician services with a copay between $0 and $10, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, and physician specialist services with a copay between $0 and $40. Mental health specialty services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a copay between $0 and $40. The plan does not cover podiatry services, and opioid treatment program services have no copay. Other health care professional services have a copay between $0 and $40. Psychiatric services, including individual and group sessions, have a $40 copay. Routine chiropractic care is not covered.
Preventive Services See details
The "True Blue Rx Option II (HMO)" plan covers preventive services, including annual physical exams and additional preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In addition, this plan covers memory fitness with no copay. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a $40 copay, while routine hearing exams have no copay, and the fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have a copay between $499 and $999, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with no copay, and routine eye exams with a $20 copay. Eyewear is covered with no copay, and contact lenses, eyeglasses (lenses and frames) have a copay between $0 and $35. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are partially covered under the True Blue Rx Option II (HMO) plan, with a $30 copay for Medicare Dental Services; however, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B drugs, are covered by the True Blue Rx Option II (HMO) plan. 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 under the True Blue Rx Option II (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the True Blue Rx Option II (HMO) plan, with a 20% coinsurance for Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, and no copay. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of at most $30 and coinsurance of at most 15%, while Lab Services have a $10 copay. Diagnostic Radiological Services have a copay of at most $250, and Therapeutic Radiological Services have coinsurance of at most 15%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by True Blue Rx Option II (HMO) 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 technically covered, but not in practice. 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, but require prior authorization. You will have 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 for SNF, 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 benefit of $60 every three months, including nicotine replacement therapy and naloxone coverage, while acupuncture, meal benefits, and other services are not covered. Other services also cover convenience care up to $2500 per year.
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