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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.
True Blue Rx Preferred (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 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 $29.00. 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 $5000.00 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 Preferred (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 used. For example, you will pay a $7 copay for preferred generic drugs and a $47 copay for standard generic drugs at standard pharmacies. The plan has no copay for specialty tier 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 have copays that vary by service. Emergency, preventive, and home health services often have no copay. The plan also covers services like hearing, vision, and dental, each with their own cost structures. The plan also covers services such as Ambulance, medical equipment, diagnostic, and radiological services. However, some services like acupuncture and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered under the True Blue Rx Preferred (HMO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $250 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered by the True Blue Rx Preferred (HMO) plan. Outpatient hospital services have a copay between $0 and $250, observation services have a $250 copay, and individual and group outpatient substance abuse sessions have a $20 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the True Blue Rx Preferred (HMO) plan, but requires prior authorization. You will have a $35 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the True Blue Rx Preferred (HMO) plan. Medicare-covered ground and air ambulance services have a $255 copay, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the True Blue Rx Preferred (HMO) plan with a $100 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $40, and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services have a copay of $0-$15. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $20 copay. Physician Specialist Services have a copay of $0-$25. Individual and Group Mental Health Specialty Sessions have a $20 copay. Other Health Care Professional services have a copay of $0-$25. Individual and Group Psychiatric Sessions have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a copay of $0-$20. Additional Telehealth Benefits have a copay of $0-$35. Opioid Treatment Program Services have no copay.
Preventive Services See details
The True Blue Rx Preferred (HMO) plan covers preventive services, including annual physical exams, health education, kidney disease education services, and other preventive services such as glaucoma screenings, with no copay. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered. The plan also covers fitness benefits with no copay.
Hearing Services See details
Hearing services are covered, including hearing exams with a $35 copay. Routine hearing exams have no copay, and fitting/evaluation for hearing aids is covered with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $999, but prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The True Blue Rx Preferred (HMO) plan covers vision services, including eye exams with no copay. Eyewear is covered, including contact lenses with a copay between $0 and $35, and eyeglasses (lenses and frames) with a $35 copay; however, eyeglass lenses and frames are not covered.
Dental Services See details
Dental services with the True Blue Rx Preferred (HMO) plan include a $35 copay for Medicare dental services and no copay for other dental services. Oral exams, dental x-rays, cleaning, fluoride treatment, restorative services, and maxillofacial surgery are all covered, but there are limitations on the number of visits and the frequency of services. Orthodontic services 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 coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the True Blue Rx Preferred (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the True Blue Rx Preferred (HMO) plan, with no copay for Durable Medical Equipment (DME), and a coinsurance between 0% and 20%. Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance. For Diabetic Supplies, there is no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services, and a coinsurance for Medicare-covered lab services; Diagnostic Procedures/Tests have a maximum copay of $30 and a coinsurance of at most 20%, while Lab Services have no copay. Radiological Services include coverage for diagnostic and therapeutic services; Diagnostic Radiological Services have a maximum copay of $150, while 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, however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by True Blue Rx Preferred (HMO), but all of the sub-services are not covered. There is a copay for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the True Blue Rx Preferred (HMO) plan, with prior authorization required. For days 1-20 and 56-100, there is no copay, while days 21-55 have a $203 copay.
Other Services See details
The True Blue Rx Preferred (HMO) plan does not cover 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, but require prior authorization and have a maximum plan benefit coverage of $2500.00 every year.
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