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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 $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
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 $5700.00 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. After the deductible, you will pay the following for your prescriptions. For preferred generic drugs, you will pay a $7 copay at standard and mail-order pharmacies. For standard generic drugs, you will pay a $47 copay at standard and mail-order pharmacies. For preferred brand drugs, you pay 50% coinsurance, and for non-preferred drugs, you pay 31% coinsurance. The specialty tier has 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 Preferred (HMO) plan offers a wide range of benefits. Inpatient hospital stays have a copay, and emergency services have a copay of $100. The plan also includes coverage for outpatient services, primary care, preventive services, hearing, vision, and dental services, each with its own copays or no copays. Additional benefits include ambulance services, home infusion, dialysis, medical equipment, and diagnostic services, with varying copays or coinsurance. The plan also covers skilled nursing facility services with a copay, and other services such as OTC items. Some services, such as cardiac rehabilitation and certain home health services, are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay 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. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services are covered by the True Blue Rx Preferred (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $250, observation services have a $250 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $20, and outpatient blood services are covered with three pints of deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the True Blue Rx Preferred (HMO) plan, with a $35 copay. Prior authorization is required for this benefit.
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 copay of $255.00, with no coinsurance, but 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 there is no coinsurance. Urgently Needed Services have a copay between $0 and $40, and there is no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a copay between $0 and $15, Chiropractic Services with a $20 copay (except for Routine Care, which is not covered), Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay between $0 and $25, and Mental Health Specialty Services, including Individual and Group Sessions, each with a $20 copay. The plan also covers Other Health Care Professional services with a copay between $0 and $25, Psychiatric Services, including Individual and Group Sessions, each with a $35 copay, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $30, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services with no copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams, Health Education, Kidney Disease Education Services, and other preventive services. The plan also covers Fitness Benefits with no copay. However, 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.
Hearing Services See details
Hearing Services are covered, including hearing exams and prescription hearing aids. Routine hearing exams have no copay, while fitting/evaluation for hearing aids have no copay; prescription hearing aids have a copay between $499 and $999. Prescription hearing aids for the inner, outer, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include routine 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. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered under the True Blue Rx Preferred (HMO) plan, with a $35 copay for Medicare Dental Services and no copay for Other Dental Services. Orthodontic Services have a maximum benefit of $500 per year. Implants and fixed prosthodontics have a $300 copay, while oral and maxillofacial surgery has no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. 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, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the True Blue Rx Preferred (HMO) plan. You will pay a coinsurance of 20% for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered by the True Blue Rx Preferred (HMO) plan, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies and Medical Supplies with 20% coinsurance. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay of up to $30 and coinsurance up to 20%, lab services with no copay, diagnostic radiological services with a copay of up to $200, therapeutic radiological services with coinsurance up to 20%, and outpatient X-ray services with 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 not covered by the True Blue Rx Preferred (HMO) plan. Though the plan does cover some cardiac and pulmonary rehabilitation services, it does not cover the specific services listed.
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. There is no copay for days 1-20 and days 56-100, but there is a $203 copay for days 21-55.
Other Services See details
Other Services for the True Blue Rx Preferred (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $105 every three months, and "Other 1" services which require prior authorization and a maximum benefit of $2500 per year; however, acupuncture, 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 are not covered.
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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.
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