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True Blue Rx 33 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx 33 (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 33 (HMO) in 2026, please refer to our full plan details page.
True Blue Rx 33 (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 33 (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 33 (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 33 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $59.00. 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 33 (HMO) plan features an annual drug deductible of $175. Tier 1 preferred generic drugs are highly affordable with no copay for up to a three-month supply at both preferred and standard pharmacies. For Tier 2 generic drugs, copays start as low as $6 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, or $47 at standard pharmacies. Tier 4 non-preferred drugs are subject to a flat 25% coinsurance across all pharmacy options. Specialty drugs in Tier 5 require a 28% coinsurance for a one-month supply.
Additional Benefits
The True Blue Rx 33 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and routine lab tests. For inpatient hospital stays, members pay a $425 daily copay for days one through five, followed by no copay for days six through 90. Emergency room visits carry a $130 copay, which is waived if admitted, while specialist visits and physical therapy require a $40 copay. This plan also includes essential dental, vision, and hearing benefits to help reduce your out-of-pocket costs. Routine dental cleanings and annual eye exams are covered with no copay, while eyeglasses require a $35 copay. Hearing exams have a $20 copay, and durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
True Blue Rx 33 (HMO) inpatient hospital care is covered with no coinsurance, featuring a $425 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by True Blue Rx 33 (HMO) include outpatient hospital care with a $0 to $500 copay and 20% coinsurance, and ambulatory surgical center visits with no copay and 20% coinsurance. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
True Blue Rx 33 (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
True Blue Rx 33 (HMO) covers ground and air ambulance services with a $320 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
True Blue Rx 33 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
True Blue Rx 33 (HMO) covers primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and psychiatric services require a $40 copay and no coinsurance. Mental health specialty services have a $35 copay and no coinsurance, telehealth ranges from a $0 to $40 copay with no coinsurance, and both podiatry and chiropractic services are not covered.
Preventive Services See details
True Blue Rx 33 (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. These benefits are partially covered, as sub-services such as health education, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
True Blue Rx 33 (HMO) hearing services are covered with no deductible, featuring a $20 copay and no coinsurance for hearing exams. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $999, but OTC hearing aids and inner, outer, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by True Blue Rx 33 (HMO) with no coinsurance or deductibles, featuring no copay for an annual routine eye exam and a $35 copay for eyeglasses every two years. Contact lenses are covered with a $0 to $35 copay up to a $100 limit, but other eye exams, individual eyeglass lenses, and individual frames are not covered.
Dental Services See details
True Blue Rx 33 (HMO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance, and select preventive services like cleanings, exams, x-rays, and fluoride with no copay and no coinsurance. Other diagnostic and preventive services, restorative services, endodontics, periodontics, prosthodontics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
True Blue Rx 33 (HMO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the True Blue Rx 33 (HMO) plan with no copay and a 20% coinsurance. Members are required to obtain a referral to receive these covered services.
Medical Equipment See details
True Blue Rx 33 (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, and prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under True Blue Rx 33 (HMO) with prior authorization and referrals required. Outpatient diagnostic tests require a $35 copay and no coinsurance, while lab services and diagnostic radiological services have no copay and no coinsurance. Outpatient X-rays require a $25 copay and no coinsurance, while therapeutic radiological services carry a 20% coinsurance and no copay.
Home Health Services See details
True Blue Rx 33 (HMO) covers Home Health Services with no copay and no coinsurance, though a referral is required to receive these services.
Cardiac Rehabilitation Services See details
True Blue Rx 33 (HMO) covers cardiac rehabilitation services with no copay and no coinsurance, though a referral is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
True Blue Rx 33 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral, and allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20 and days 56 to 100, but a $218 daily copay applies for days 21 to 55, with additional days beyond Medicare-covered limits not covered.
Other Services See details
Other services are partially covered by True Blue Rx 33 (HMO), featuring convenience care with no copay and no coinsurance up to a $2,500 annual limit, though prior authorization is required. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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