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True Blue Rx 32PSP (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx 32PSP (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 32PSP (HMO) in 2026, please refer to our full plan details page.
True Blue Rx 32PSP (HMO) is a HMO plan offered by Gemstone Holdings, Inc. available for enrollment in 2026 to people living in Select Counties in Idaho. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that True Blue Rx 32PSP (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 32PSP (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 32PSP (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.00. 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 $5900.00 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 32PSP (HMO) plan features an annual prescription drug deductible of $175. For Tier 1 preferred generic drugs, members enjoy no copay for one-, two-, or three-month supplies at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic medications cost a $6 copay for a one-month supply at preferred pharmacies and standard mail order, or $15 at standard pharmacies. Tier 3 preferred brand drugs require a $40 copay for a one-month supply at preferred pharmacies and standard mail order, increasing to a $47 copay at standard pharmacies. Tier 4 non-preferred drugs have a 25% coinsurance across all fulfillment methods, while Tier 5 specialty drugs require a 28% coinsurance for a one-month supply.
Additional Benefits
The True Blue Rx 32PSP (HMO) plan offers comprehensive coverage for essential medical services, featuring no copay for primary care visits, routine preventive services, and home health care. For inpatient hospital stays, members pay a $425 daily copay for days 1 through 5 and no copay for days 6 through 90. Specialist visits require a $35 to $40 copay, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also includes coverage for routine dental, vision, and hearing exams with no copay, though specialized treatments, hearing aids, and eyewear require varying copays. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay. Additionally, skilled nursing facility care is covered with no copay for days 1 through 20 and days 56 through 100.
Inpatient Hospital See details
True Blue Rx 32PSP (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute hospital days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
True Blue Rx 32PSP (HMO) covers outpatient hospital services with a $0 to $500 copay and 20% coinsurance, and observation services with a $500 copay and 20% coinsurance. Ambulatory surgical center services feature no copay and 20% coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
True Blue Rx 32PSP (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
True Blue Rx 32PSP (HMO) covers ground and air ambulance services with a $320 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
True Blue Rx 32PSP (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with no copays and no coinsurance.
Primary Care See details
True Blue Rx 32PSP (HMO) features primary care doctor visits and opioid treatment services with no copay and no coinsurance, while specialist, therapy, and mental health services have copays ranging from $35 to $40 and no coinsurance. Podiatry and chiropractic services are not covered, but telehealth options are offered with copays from $0 to $40 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by True Blue Rx 32PSP (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney education, and fitness benefits. However, additional preventive services such as health education, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
True Blue Rx 32PSP (HMO) covers hearing exams with a $20 copay (routine annual exams have no copay) and no coinsurance, though a referral is required. Hearing aids are partially covered with copays ranging from $499 to $999 and no coinsurance for prescription models, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
True Blue Rx 32PSP (HMO) partially covers vision services with no deductibles or coinsurance, offering one routine eye exam annually with no copay, though other eye exam services are not covered. Eyewear is also partially covered with no coinsurance, featuring a $0 to $35 copay for contact lenses and a $35 copay for eyeglasses every two years, while standalone eyeglass lenses and frames are not covered.
Dental Services See details
Dental services are partially covered by True Blue Rx 32PSP (HMO), with Medicare-covered dental requiring a $40 copay and no coinsurance, and covered preventive services—such as select oral exams, cleanings, x-rays, and fluoride—offered with no copay or coinsurance. Non-covered services include other diagnostic and preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by True Blue Rx 32PSP (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
True Blue Rx 32PSP (HMO) covers dialysis services with no copay and a 20% coinsurance, although a referral is required.
Medical Equipment See details
Medical equipment covered by True Blue Rx 32PSP (HMO) generally requires no copay and a 20% coinsurance, which applies to durable medical equipment, prosthetics, and diabetic supplies. Diabetic therapeutic shoes and inserts are also covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by True Blue Rx 32PSP (HMO) with prior authorization and referrals required. There is no copay or coinsurance for lab services and diagnostic radiology, while diagnostic tests require a $35 copay, outpatient X-rays require a $25 copay, and therapeutic radiology incurs a 20% coinsurance.
Home Health Services See details
Home health services are covered under True Blue Rx 32PSP (HMO) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
True Blue Rx 32PSP (HMO) covers cardiac rehabilitation services with no copay and no coinsurance when a referral is obtained, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by True Blue Rx 32PSP (HMO) with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and days 56 through 100, a $218 daily copay applies for days 21 through 55, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
True Blue Rx 32PSP (HMO) partially covers Other Services, excluding acupuncture, over-the-counter items, and meal benefits. Convenience Care is covered with no copay and no coinsurance up to a maximum of $2,500 annually, though prior authorization is required.
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