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Medicare HMO Blue PlusRx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare HMO Blue PlusRx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare HMO Blue PlusRx (HMO) in 2025, please refer to our full plan details page.
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 3.5 out of 5 stars in 2025.
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.
For Medicare HMO Blue PlusRx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $194.00. 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 $200.00 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 $3800.00 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 Medicare HMO Blue PlusRx (HMO) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at a preferred pharmacy, and a $10 copay at a standard pharmacy. For non-preferred drugs, you will pay 29% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Medicare HMO Blue PlusRx (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $125 copay, outpatient services with varying copays, and emergency services with a $140 copay. It also provides coverage for primary care, preventive services, and home health services with no copay. This plan includes benefits for hearing and vision services, such as routine hearing exams with no copay and eye exams with a copay. Dental services are limited to oral exams, x-rays, and cleaning with a $30 copay. Additionally, the plan covers home infusion bundled services, dialysis services with 20% coinsurance, and medical equipment with 10% coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, you will pay a $125 copay for days 1-7, and no copay for days 8-90, while for Inpatient Hospital Psychiatric you will pay a $125 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with a $100 copay, and Outpatient Substance Abuse Services with a $10 copay for both individual and group sessions. This plan also covers Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare HMO Blue PlusRx (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare HMO Blue PlusRx (HMO) plan. Ground and air ambulance services have a $150 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medicare HMO Blue PlusRx (HMO) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a copay between $0 and $30 with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $75 copay with no coinsurance.
Primary Care See details
The Medicare HMO Blue PlusRx (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, and physician specialist services and additional telehealth benefits have a copay between $0 and $30. Individual sessions for mental health and psychiatric services have a copay between $0 and $10, and group sessions for mental health and psychiatric services have a $10 copay. Physical therapy and speech-language pathology services have a $15 copay.
Preventive Services See details
The Medicare HMO Blue PlusRx (HMO) plan covers various preventive services, including annual physical exams, health education, kidney disease education services, and more, with specific services like wigs for hair loss related to chemotherapy and weight management programs having maximum benefit coverage amounts. Additional services like in-home safety assessments, personal emergency response systems (PERS), and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and Fitting/Evaluation for Hearing Aids is covered. Prescription hearing aids are covered, but the plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0-$30, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 every two years, and upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams with a $30 copay, dental x-rays, and prophylaxis (cleaning) with a $30 copay. Fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 10%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 10%.
Dialysis Services See details
Dialysis Services are covered with prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 10% coinsurance and Prosthetics/Medical Supplies with 10% coinsurance for Medicare-covered items, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests, and Lab Services are not covered. For Diagnostic Radiological Services, there is a copay of at most $150.00, and for Outpatient X-Ray Services, there is a $5.00 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medicare HMO Blue PlusRx (HMO), though the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. The cost sharing includes a copay, with more information available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medicare HMO Blue PlusRx (HMO) plan, with a prior authorization requirement. For days 1-20, there is no copay, days 21-44 have a $100 copay, and days 45-100 have no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are partially covered, but acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The plan provides a meal benefit for a chronic illness.
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