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True Blue Rx 34 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx 34 (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 34 (HMO) in 2026, please refer to our full plan details page.
True Blue Rx 34 (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 34 (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 34 (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 34 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $79.50. 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 $150.00 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 34 (HMO) prescription drug plan features an affordable $150 annual drug deductible and offers excellent savings on generic medications. Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies at preferred pharmacies, standard pharmacies, and standard mail order. Tier 2 generic drugs are also highly accessible, with copays starting at just $7 for a one-month supply when using a preferred pharmacy or standard mail order. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs carry a $40 copay for a one-month supply at preferred pharmacies and standard mail order. Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy options, while Tier 5 specialty drugs require a 27% coinsurance for a one-month supply. Utilizing preferred pharmacies and standard mail order options will help you minimize your out-of-pocket prescription costs under this plan.
Additional Benefits
The True Blue Rx 34 (HMO) plan provides robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. Inpatient hospital stays require a $425 copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance. Outpatient hospital services range from no copay up to a $500 copay with 20% coinsurance, while emergency room visits carry a $130 copay that is waived if admitted. For specialized care, the plan offers routine dental cleanings, annual eye exams, and hearing tests with no copay, though hearing aids and eyewear require copays. Specialist visits and physical therapy sessions carry a $40 copay, while durable medical equipment is covered with no copay and a 20% coinsurance. Skilled nursing facility stays are also affordable, with no copay for the first 20 days and a $218 daily copay for days 21 through 55.
Inpatient Hospital See details
True Blue Rx 34 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, featuring a $425 copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
True Blue Rx 34 (HMO) covers outpatient hospital services with a $0 to $500 copay and 20% coinsurance, and observation services with a $500 copay and coinsurance. Ambulatory surgical center services feature no copay and 20% coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance, and blood services have no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by True Blue Rx 34 (HMO) 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 34 (HMO) covers Medicare-covered ground and air ambulance services with a $320 copay and no coinsurance, requiring prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by True Blue Rx 34 (HMO) with a $130 copay and no coinsurance, which is 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 34 (HMO) covers primary care visits and opioid treatment with no copay and no coinsurance, while specialists, physical, occupational, and speech therapies require a $40 copay and no coinsurance. Mental health and psychiatric sessions have a $35 to $40 copay with no coinsurance, but podiatry is not covered and only some chiropractic services are covered as routine and other chiropractic services are excluded.
Preventive Services See details
True Blue Rx 34 (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs. However, additional preventive services are only partially covered; while fitness benefits and remote access technologies are included, the plan does not cover health education, in-home safety assessments, personal emergency response systems (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 benefits, 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, or counseling services.
Hearing Services See details
Hearing services are partially covered by True Blue Rx 34 (HMO), which offers hearing exams for a $20 copay and no coinsurance, while routine annual exams have no copay. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $499 and $999, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
True Blue Rx 34 (HMO) vision services are partially covered with no deductibles and no coinsurance, featuring one annual routine eye exam with no copay. Covered eyewear includes contact lenses with a $0 to $35 copay and eyeglasses (lenses and frames) with a $35 copay, while other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Dental Services See details
True Blue Rx 34 (HMO) provides partially covered dental services, featuring Medicare-covered dental care for a $40 copay and no coinsurance, alongside select preventive services like oral exams, cleanings, x-rays, and fluoride with no copay and no coinsurance. However, other diagnostic and preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
True Blue Rx 34 (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs carry no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by True Blue Rx 34 (HMO) with no copay and a 20% coinsurance, though a referral is required.
Medical Equipment See details
True Blue Rx 34 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered with no copay and a 20% coinsurance, while diabetic supplies feature no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by True Blue Rx 34 (HMO), requiring prior authorization and referrals for all services. Diagnostic tests have a $35 copay and lab services have no copay (both with no coinsurance), while outpatient X-rays require a $25 copay with coinsurance, diagnostic radiology copays start at $0, and therapeutic radiology requires a minimum 20% coinsurance plus a copay.
Home Health Services See details
Home Health Services are covered by True Blue Rx 34 (HMO) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by True Blue Rx 34 (HMO) with no copay and no coinsurance, though a referral is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
True Blue Rx 34 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, although prior authorization and referrals are required. There is no copay for days 1 to 20 and 56 to 100, while days 21 to 55 require a $218 daily copay, with no coverage provided for additional days beyond the Medicare-covered 100 days.
Other Services See details
True Blue Rx 34 (HMO) offers partial coverage for other services, excluding acupuncture, over-the-counter items, and meal benefits. Covered convenience care services feature no copay and no coinsurance up to a maximum annual benefit of $2,500, though prior authorization is required.
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