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Medicare HMO Blue ValueRx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare HMO Blue ValueRx (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 ValueRx (HMO) in 2025, please refer to our full plan details page.
Medicare HMO Blue ValueRx (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, 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 ValueRx (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 ValueRx (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 ValueRx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.00. 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 $320.00 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 $3750.00 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 ValueRx (HMO) plan has a $320 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and where you fill your prescription. For a 30-day supply, you'll pay a $6 copay for preferred generic drugs at a preferred or mail-order pharmacy, and $12 at a standard pharmacy. For non-preferred drugs, you pay 27% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Medicare HMO Blue ValueRx (HMO) plan offers a range of benefits with varying costs. It includes coverage for inpatient and outpatient services, with copays ranging from $0 to $330 depending on the service. The plan also covers primary care, preventive services like wigs for hair loss and weight management programs, and services for hearing, vision, and dental. Additional benefits include ambulance services, emergency services, and home health services with no copay. The plan provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities. However, some services like certain dental, vision, and hearing services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a copay of $330 for days 1-7 and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a copay of $275 for days 1-5 and no copay for days 6-90. Additional days for both services are covered, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $250 copay, observation services with a $250 copay, ambulatory surgical center (ASC) services with a $200 copay, and outpatient substance abuse services with a $25-$25 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare HMO Blue ValueRx (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare HMO Blue ValueRx (HMO) plan, including both ground and air ambulance services, each with a $250 copay and 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 ValueRx (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a copay between $0 and $40, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $105 copay. No coinsurance is applied to these services.
Primary Care See details
The Medicare HMO Blue ValueRx (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $0-$40 copay, individual mental health sessions with a $0-$25 copay, group mental health sessions with a $25 copay, other health care professional services with a $10-$40 copay, individual psychiatric sessions with a $25 copay, group psychiatric sessions with a $25 copay, physical therapy and speech-language pathology services with a $20 copay, and additional telehealth benefits with a $0-$40 copay. The plan does not cover routine chiropractic care or podiatry services.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. The plan covers wigs for hair loss related to chemotherapy with a maximum plan benefit coverage amount of $500 every year, and weight management programs with a maximum plan benefit coverage amount of $150 every year. Additionally, the plan covers fitness benefits including memory fitness with a maximum plan benefit coverage amount of $150 every year, and other services like health education, enhanced disease management, and remote access technologies. Some services, such as in-home safety assessments, personal emergency response systems, and counseling services are not covered.
Hearing Services See details
The Medicare HMO Blue ValueRx (HMO) plan covers hearing exams with a $10 copay, as well as routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $699 and $999 for all types, but prescription hearing aids of the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a copay of $10-$40, and eyewear benefits that includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 every two years, while upgrades are not covered.
Dental Services See details
Dental services include oral exams with a $40 copay, dental x-rays, and prophylaxis (cleaning) with a $40 copay. Fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies, also with 20% coinsurance. Diabetic Equipment is covered, 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 by the Medicare HMO Blue ValueRx (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a $250 copay, and Outpatient X-Ray Services have a $10 copay; however, Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medicare HMO Blue ValueRx (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Medicare HMO Blue ValueRx (HMO) plan, requiring prior authorization. There is no copay for days 1-20, a $160 copay for days 21-44, and no copay for days 45-100. Additional days beyond Medicare coverage and non-Medicare covered stays for SNF are not covered.
Other Services See details
Other Services, for the Medicare HMO Blue ValueRx (HMO) plan, includes a meal benefit for chronic illnesses, and does not require authorization or a referral. However, 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.
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