A non-government entity
True Blue Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx (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 (HMO) in 2025, please refer to our full plan details page.
True Blue Rx (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 (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 (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 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $78.00. 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 $6200.00 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 (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 (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 example, in the initial coverage phase, you will pay a $15 copay for preferred generic drugs at a standard or mail order pharmacy. For specialty tier drugs, there is no copay.
Additional Benefits
The True Blue Rx (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, with no copay for days 7-90 of acute care, while outpatient services vary depending on the specific service. Emergency and urgent care services have copays, and primary care visits can have no copay or a small copay, while specialist visits have a copay. Additional benefits include hearing, vision, and dental coverage, with copays or coinsurance for specific services. The plan also covers home health services with no copay, and skilled nursing facility stays with no copay for some days. Additional benefits such as Over-the-Counter (OTC) Items and Convenience Care are available with maximum annual benefits.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $295 for days 1-6, and no copay for days 7-90 for acute care; psychiatric care has a copay of $290 for days 1-6, and no copay for days 7-90. 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, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, ambulatory surgical center services have no copay, and both individual and group sessions for outpatient substance abuse have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the True Blue Rx (HMO) plan, and requires prior authorization. You will pay a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the True Blue Rx (HMO) plan. Ground and Air Ambulance Services have a $270 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 under the True Blue Rx (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
Primary Care Physician Services have a copay between $0 and $10. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $40 copay. Physician Specialist Services have a copay between $0 and $40. Mental Health Specialty Services, Individual and Group Sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $40. Opioid Treatment Program Services have no copay. Other Health Care Professional and Psychiatric Services have a copay between $0 and $40. Podiatry Services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and Annual Physical Exams, are covered. Additional Preventive Services, Health Education, Kidney Disease Education Services, and Other Preventive Services are also covered, although In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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, and Counseling Services are not covered. Fitness Benefit (Memory Fitness) has no copay.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $40 copay, while prescription hearing aids have a copay between $499 and $999.
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 have a copay between $0 and $35. Eyeglasses (lenses and frames) have a $35 copay, and eyeglass lenses and frames are not covered.
Dental Services See details
The True Blue Rx (HMO) plan covers Medicare Dental Services with a $40 copay and Other Dental Services with a $20 copay, up to a maximum of $500 per year. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered, but orthodontic services, restorative services, and other 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 Other Medicare Part B Drugs. The coinsurance for all Part B drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the True Blue Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the True Blue Rx (HMO) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies; Diabetic Supplies have no copay, while 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, with prior authorization required. Diagnostic Procedures/Tests may have a copay up to $30 and a coinsurance up to 20%, Lab Services have a $5 copay, Diagnostic Radiological Services may have a copay up to $250, and Therapeutic Radiological Services have a coinsurance up to 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered 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 (HMO) plan. While the plan states that there is a copay for these services, all sub-services are listed as not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the True Blue Rx (HMO) plan, with prior authorization required. For days 1-20 and 56-100, there is no copay, but for days 21-55, the copay is $203.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $65 every three months, and Convenience Care with a maximum benefit of $2500 every year. 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.
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