Medicare HMO Blue PlusRx (HMO)

Medicare HMO Blue PlusRx (HMO) is a HMO plan offered by Blue Cross and Blue Shield of Massachusetts, Inc. available for enrollment in 2025 to people living in Massachusetts except Berkshire Dukes and Nantucket. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that Medicare HMO Blue PlusRx (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 Medicare HMO Blue PlusRx (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.

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:

Drug Coverage

The Medicare HMO Blue PlusRx (HMO) plan features a $200 drug deductible and offers affordable copays during the initial coverage phase. Tier 1 preferred generic drugs are available with no copay when using a preferred pharmacy or standard mail order service. For Tier 2 generic medications, you will pay a low copay starting at $5 for a one-month supply at preferred pharmacies or standard mail order. Brand-name and specialty medications fall into higher tiers, with Tier 3 preferred brand drugs requiring a $42 copay for a one-month supply at preferred pharmacies. Tier 4 non-preferred drugs cost $95 for a one-month supply at preferred pharmacies, while Tier 5 specialty drugs require a 29% coinsurance across all pharmacy options. Utilizing preferred pharmacies or standard mail order services generally provides the lowest out-of-pocket costs under this plan.

Additional Benefits

The Medicare HMO Blue PlusRx (HMO) plan offers comprehensive coverage with predictable cost-sharing, featuring no coinsurance for inpatient hospital stays, outpatient services, and emergency care. Inpatient stays require a daily copay of $135 for the first seven days of acute care, while outpatient hospital services carry a $150 copay. Additionally, policyholders pay no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialty and supplemental care, the plan provides preventive dental care with no copay and routine eye exams with a copay up to $30, alongside a $200 eyewear allowance with no deductible. Specialist visits and mental health services feature low copays ranging from no copay to $30, while diagnostic services and home infusions require no copay. Durable medical equipment is available with no copay and a 10% coinsurance, ensuring affordable access to essential medical devices.