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True Blue Rx 36 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for True Blue Rx 36 (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 36 (HMO) in 2026, please refer to our full plan details page.
True Blue Rx 36 (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 36 (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 36 (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 36 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $94.00. 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 $130.00 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 36 (HMO) plan features an annual drug deductible of $130, offering affordable prescription drug coverage. For Tier 1 preferred generic drugs, members enjoy no copay for one-month, two-month, and three-month supplies at preferred, standard, and standard mail-order pharmacies. Tier 2 generic medications cost as low as a $7 copay for a one-month supply at preferred or standard mail-order pharmacies, while standard pharmacies charge a $15 copay. Tier 3 preferred brand drugs require a $40 copay for a one-month supply at preferred and standard mail-order pharmacies, compared to $47 at standard pharmacies. Tier 4 non-preferred drugs have a flat 27% coinsurance across all pharmacy options, and Tier 5 specialty drugs require a 29% coinsurance for a one-month supply. This structure provides clear options for managing your prescription costs through preferred pharmacies and mail-order services.
Additional Benefits
The True Blue Rx 36 (HMO) plan offers robust coverage for essential medical services, featuring no copay or coinsurance for primary care visits and preventive care. For inpatient hospital stays, members pay a daily copay of $425 for the first five days and no copay for days six through ninety. Emergency room visits require a $130 copay, which is waived if admitted, while specialist visits carry a $40 copay. Routine dental cleanings, annual eye exams, and yearly hearing tests are fully covered with no copay or coinsurance. Durable medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, the plan covers skilled nursing facility stays 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 36 (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 per stay. Unlimited additional days for acute stays are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
True Blue Rx 36 (HMO) covers outpatient hospital services with a copay ranging from no copay to $500 and 20% coinsurance, alongside ambulatory surgical center services featuring no copay and 20% coinsurance. Outpatient substance abuse services require a $35 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
True Blue Rx 36 (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under True Blue Rx 36 (HMO) feature covered ground and air ambulance services with a $320 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
True Blue Rx 36 (HMO) covers emergency services with a $130 copay—which is waived if you are admitted to the hospital within 24 hours—and urgently needed services with a $50 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and transportation services are also fully covered with no copay and no coinsurance.
Primary Care See details
True Blue Rx 36 (HMO) primary care benefits feature no copay and no coinsurance for primary care doctor visits and opioid treatment, while specialist visits, physical, occupational, speech, and psychiatric therapies require a $40 copay with no coinsurance. Mental health specialty services carry a $35 copay and no coinsurance, and telehealth services range from a $0 to $40 copay with no coinsurance. Podiatry is not covered, and while some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by True Blue Rx 36 (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings, though some services require a referral. While fitness benefits and remote access technologies are covered, other additional preventive services—such as health education, weight management programs, and in-home safety assessments—are not covered.
Hearing Services See details
True Blue Rx 36 (HMO) hearing services are partially covered, offering exams with a $20 copay (no copay for one annual routine exam), no coinsurance, and no deductible. Prescription hearing aids are also partially covered with no coinsurance and copays from $499 to $999 for up to two devices per year, while inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
True Blue Rx 36 (HMO) partially covers vision services with no deductibles and no coinsurance, offering routine annual eye exams with no copay and eyewear with copays ranging from no copay to $35. Other eye exam services, eyeglass lenses, and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered under True Blue Rx 36 (HMO), featuring Medicare-covered dental services for a $40 copay and no coinsurance, and preventive services like exams, cleanings, x-rays, and fluoride with no copay and no coinsurance. However, other diagnostic, other preventive, restorative, endodontic, periodontic, prosthodontic, oral surgery, orthodontic, and implant services are not covered.
Home Infusion bundled Services See details
True Blue Rx 36 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs carry no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by True Blue Rx 36 (HMO) with no copay and a 20% coinsurance, and a referral is required to receive care.
Medical Equipment See details
True Blue Rx 36 (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 and inserts are covered with no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
True Blue Rx 36 (HMO) covers diagnostic and radiological services with prior authorization and referral requirements. Diagnostic tests require a $35 copay with no coinsurance, lab services and diagnostic radiological services feature no copay and no coinsurance, and outpatient x-rays require a $25 copay with coinsurance. Therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
True Blue Rx 36 (HMO) covers Home Health Services with no copay and no coinsurance, although a referral is required to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the True Blue Rx 36 (HMO) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
True Blue Rx 36 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1-20 and 56-100, and a $218 daily copay for days 21-55. Prior authorization and referrals are required, and additional days beyond standard Medicare coverage are not covered.
Other Services See details
Other services are partially covered by True Blue Rx 36 (HMO), which features a convenience care benefit with no copay and no coinsurance up to a maximum of $2,500 per year, though prior authorization is required. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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