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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 2026, 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 4.5 out of 5 stars in 2026.
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 $65.00. 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 features an annual drug deductible of $320. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge an $8 copay for a one-month supply. Tier 2 generic drugs cost as little as a $6 copay for a one-month supply at preferred pharmacies and standard mail order, compared to a $12 copay at standard pharmacies. For Tier 3 preferred brand drugs, one-month copays start at $42 at preferred pharmacies and standard mail order, or $47 at standard pharmacies. Tier 4 non-preferred drugs require a $95 copay at preferred pharmacies and standard mail order, or $100 at standard pharmacies for a one-month supply. Specialty drugs in Tier 5 are subject to a 28% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Medicare HMO Blue ValueRx (HMO) plan offers comprehensive medical coverage with fixed copayments and no coinsurance for most standard services. Primary care visits require a $10 copay, while specialist visits and urgent care range from no copay to a $40 copay. For hospital care, inpatient stays carry a $350 daily copay for the first seven days, and emergency room visits require a $140 copay which is waived if you are admitted. Preventive care, routine dental cleanings, and home health services are fully covered with no copay and no coinsurance. Routine hearing and vision exams feature low copays between $10 and $40, alongside a $200 eyewear allowance every two years with no copay. For specialized needs, durable medical equipment and dialysis require a 20% coinsurance and no copay.
Inpatient Hospital See details
Medicare HMO Blue ValueRx (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays and a $275 daily copay for days 1 to 5 of psychiatric stays, with no copay for subsequent days. The benefit is partially covered, as prior authorization is required and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Medicare HMO Blue ValueRx (HMO) with no coinsurance, featuring a $250 copay for outpatient hospital and observation services and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $25 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Medicare HMO Blue ValueRx (HMO) plan with a $55 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Medicare HMO Blue ValueRx (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, which is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services are not covered under this plan.
Emergency Services See details
Medicare HMO Blue ValueRx (HMO) covers emergency services with a $140 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no coinsurance and a copay ranging from no copay to $40, while worldwide emergency, urgent, and transportation services require a $105 copay and no coinsurance.
Primary Care See details
Medicare HMO Blue ValueRx (HMO) provides primary care physician visits for a $10 copay and no coinsurance, while specialist visits range from no copay to a $40 copay with no coinsurance. Other covered services such as physical therapy, psychiatric care, and telehealth also feature no coinsurance with copays up to $40, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Medicare HMO Blue ValueRx (HMO) with no copay and no coinsurance for covered care, such as annual physical exams, kidney disease education, and select screenings. While additional benefits like memory fitness, weight management, and chemotherapy wigs are covered up to set annual limits, other services including in-home safety assessments, nutritional benefits, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by Medicare HMO Blue ValueRx (HMO), featuring a $10 copay and no coinsurance for routine hearing exams, and a $699 to $999 copay with no coinsurance for up to two annual prescription hearing aids. OTC hearing aids, as well as prescription hearing aids for the inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
Medicare HMO Blue ValueRx (HMO) offers partially covered vision services with no deductibles, including one annual routine eye exam for a $10.00 to $40.00 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200.00 combined maximum every two years, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by Medicare HMO Blue ValueRx (HMO), featuring a $40 copay and no coinsurance for Medicare-covered dental care. Preventive services such as oral exams, cleanings, and x-rays are covered with no copay and no coinsurance, while fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Medicare HMO Blue ValueRx (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Part B drugs, including chemotherapy, require no copay and up to 20% coinsurance, while insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Medicare HMO Blue ValueRx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare HMO Blue ValueRx (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medicare HMO Blue ValueRx (HMO) with no coinsurance, though prior authorization is required and therapeutic radiological services are not covered. Under this plan, there is no copay for lab services, a $10 copay for outpatient X-rays, a $0 to $10 copay for diagnostic procedures, and a minimum $250 copay for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered by the Medicare HMO Blue ValueRx (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Medicare HMO Blue ValueRx (HMO) plan, where some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Medicare HMO Blue ValueRx (HMO) with no coinsurance, though prior authorization is required and additional days beyond the standard 100 days are not covered. There is no copay for days 1 through 20 and days 45 through 100, a $160 copay for days 21 through 44, and no prior three-day hospital stay is required.
Other Services See details
Medicare HMO Blue ValueRx (HMO) partially covers Other Services, providing a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered under this plan.
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