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True Blue Rx Preferred (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx Preferred (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 Preferred (HMO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
True Blue Rx Preferred (HMO) is a HMO plan offered by Gemstone Holdings, Inc. available for the 2025 plan year 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 Preferred (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 Preferred (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 Preferred (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
Health deductible: information not available.
This plan has a $175.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4200.00 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 Preferred (HMO) plan has a $175 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, you will pay a $7 copay for preferred generic drugs at a standard pharmacy and a 50% coinsurance for preferred brand drugs at a standard pharmacy. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and will pay nothing for your Part D covered drugs.
Additional Benefits
The True Blue Rx Preferred (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including substance abuse and blood services, have copays that vary. Emergency services have a copay, and ambulance services have a higher copay. This plan includes coverage for primary care, preventive, hearing, vision, and dental services, with some services having no copay. Diagnostic, radiological, and home health services are also covered, often with no copay or a coinsurance. Additional benefits include coverage for over-the-counter items and other services, subject to certain limits and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered with a $275 copay 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 Inpatient Hospital-Acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient substance abuse services are covered, with individual and group sessions each having a copay of $20. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the True Blue Rx Preferred (HMO) plan, with a $25 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance Services, as part of the True Blue Rx Preferred (HMO) plan, are covered with a $255 copay for both ground and air ambulance services, and no coinsurance. 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 Preferred (HMO) plan. Emergency Services have a $100 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $40, and no coinsurance. Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, and no coinsurance.
Primary Care See details
The True Blue Rx Preferred (HMO) plan covers Primary Care Physician Services with a copay between $0 and $15, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a copay between $0 and $25, and Mental Health Specialty Services with a $20 copay for individual and group sessions. This plan also covers Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $25, Additional Telehealth benefits with a copay between $0 and $25, and Opioid Treatment Program Services with no copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, along with annual physical exams, health education, kidney disease education services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services have a copay, and some services like In-Home Safety Assessments, Personal Emergency Response Systems (PERS), and others are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $25 copay, as well as routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $499 and $999 for all types, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams have no copay. Contact lenses have a copay of $0-$35, and eyeglasses (lenses and frames) have a copay of $35. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services includes coverage for Medicare and other dental services. Medicare dental services have a $25 copay, while other dental services have no copay. This plan has a $500 maximum benefit per year, and covers oral exams, dental x-rays, cleaning, fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered.
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 the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the True Blue Rx Preferred (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the True Blue Rx Preferred (HMO) plan. Durable medical equipment has a coinsurance between 0% and 20%, and diabetic supplies have no copay. Medical supplies have a 20% coinsurance, 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 include coverage for all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests have a maximum copay of $30 and a coinsurance of at most 20%, while lab services have no copay. Diagnostic radiological services have a maximum copay of $200, and therapeutic radiological services have a coinsurance of at most 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the True Blue Rx Preferred (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 Preferred (HMO) plan, however, 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. There is a copay for covered 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 Preferred (HMO) plan, but require prior authorization. For days 1-20 and 56-100, there is no copay, while days 21-55 have a $203 copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other services for the True Blue Rx Preferred (HMO) plan include coverage for over-the-counter items up to $115 every three months, but acupuncture, meal benefits, and several other services are not covered. Other 1 benefits are covered with prior authorization, and there is a maximum amount of $2500 every year for convenience care.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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