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True Blue Rx 35PSP (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx 35PSP (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 35PSP (HMO) in 2026, please refer to our full plan details page.
True Blue Rx 35PSP (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 35PSP (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 35PSP (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 35PSP (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $99.00. 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 $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 35PSP (HMO) Medicare prescription drug plan features an annual drug deductible of $150. For Tier 1 preferred generic drugs, members pay no copay for one-, two-, or three-month supplies at preferred, standard, and standard mail-order pharmacies. Tier 2 generic drug copays start as low as $7 for a one-month supply at preferred pharmacies and standard mail order, rising to $15 at standard pharmacies. Tier 3 preferred brand drugs have a $40 copay for a one-month supply at preferred pharmacies and standard mail order, or $47 at standard pharmacies. For higher-tier medications, Tier 4 non-preferred drugs require a 25% coinsurance, and Tier 5 specialty drugs carry a 27% coinsurance for a one-month supply.
Additional Benefits
The True Blue Rx 35PSP (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialized care, members pay a $40 copay for specialists and a $130 copay for emergency services, which is waived if admitted. Inpatient hospital stays require a $425 daily copay for the first five days and no copay for days six through ninety, while outpatient hospital services feature a copay ranging from $0 to $500 along with a 20% coinsurance. This plan also includes essential routine benefits, featuring no copay for annual routine eye exams, preventive dental cleanings, and routine hearing exams. Prescription hearing aids and select eyewear are partially covered with set copays, and there are no deductibles for these routine vision and hearing services. Additionally, skilled nursing facility stays offer no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
True Blue Rx 35PSP (HMO) 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 per stay. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
True Blue Rx 35PSP (HMO) covers outpatient hospital services with a $0 to $500 copay and 20% coinsurance, and ambulatory surgical center services with no copay and 20% coinsurance. Outpatient substance abuse sessions require a $35 copay and no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
True Blue Rx 35PSP (HMO) covers partial hospitalization with a $140.00 copay and no coinsurance. Prior authorization and a referral are required for these covered services.
Ambulance and Transportation Services See details
True Blue Rx 35PSP (HMO) covers Medicare-approved ground and air ambulance services with a $320 copay per service and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
True Blue Rx 35PSP (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 have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copays and no coinsurance.
Primary Care See details
True Blue Rx 35PSP (HMO) covers primary care physician services and opioid treatment with no copay and no coinsurance, while telehealth services range from no copay up to a $40 copay with no coinsurance. Specialist, psychiatric, physical, occupational, and speech therapy visits require a $40 copay and no coinsurance, mental health specialty services have a $35 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by True Blue Rx 35PSP (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are partially covered, offering fitness and remote access programs, while excluding services like health education, in-home safety assessments, and nutritional therapy.
Hearing Services See details
True Blue Rx 35PSP (HMO) covers hearing exams with no deductible, no coinsurance, and a $20 copay, though annual routine exams have no copay and a referral is required. Prescription hearing aids are partially covered with copays ranging from $499 to $999 and no coinsurance for up to two devices per year, but OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are covered by True Blue Rx 35PSP (HMO) with no deductibles or coinsurance, featuring one routine eye exam per year with no copay, though other eye exam services are not covered. Eyewear is partially covered with no coinsurance, offering contact lenses with a $0 to $35 copay (up to a $100 limit every two years) and eyeglasses with a $35 copay (up to a $50 limit every two years), while individual eyeglass lenses and frames are not covered.
Dental Services See details
True Blue Rx 35PSP (HMO) partially covers dental services, offering Medicare-covered dental for a $40 copay and no coinsurance, and preventive dental services with no copay and no coinsurance. Covered benefits include select oral exams, cleanings, dental X-rays, and fluoride treatments, while other diagnostic, other preventive, restorative, endodontic, periodontic, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by True Blue Rx 35PSP (HMO) with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the True Blue Rx 35PSP (HMO) plan with no copay and a 20% coinsurance, though a referral is required to receive these services.
Medical Equipment See details
True Blue Rx 35PSP (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
True Blue Rx 35PSP (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for both. Diagnostic procedures and tests have a $35 copay with no coinsurance, lab services and diagnostic radiology have no copay, outpatient X-rays have a $25 copay, and therapeutic radiological services have a minimum 20% coinsurance.
Home Health Services See details
True Blue Rx 35PSP (HMO) covers home health services with no copay and no coinsurance, though a referral is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by True Blue Rx 35PSP (HMO) with no copay, no coinsurance, and a referral requirement. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
True Blue Rx 35PSP (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 56 to 100, a $218 daily copay for days 21 to 55, and additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
True Blue Rx 35PSP (HMO) partially covers other services, including a convenience care benefit with no copay, no coinsurance, and a $2,500 annual limit, though prior authorization is required. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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