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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 $79.00. 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 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 are also highly affordable, costing a $6 copay for a one-month supply at preferred pharmacies and standard mail order, or a $12 copay at standard pharmacies. For brand-name and specialty medications, Tier 3 preferred brands require a $42 copay at preferred pharmacies and standard mail order, compared to $47 at standard pharmacies. Tier 4 non-preferred drugs cost a $95 copay at preferred locations and standard mail order, or $100 at standard pharmacies. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Medicare HMO Blue ValueRx (HMO) plan provides comprehensive medical coverage with fixed cost-sharing, including a $10 copay for primary care visits and no coinsurance for specialist visits. For urgent medical needs, emergency room visits require a $140 copay, while inpatient acute hospital stays carry a $350 daily copay for days one through seven with no coinsurance. Outpatient hospital and ambulatory surgical services are also covered with flat copays and no coinsurance. In addition to core medical care, this plan offers routine dental cleanings, home health care, and home infusion services with no copay and no coinsurance. Routine vision and hearing exams are covered with low copays, and the plan includes a $200 eyewear allowance every two years with no deductible. Essential medical equipment and dialysis services are also accessible, requiring no copay and a 20% coinsurance.
Inpatient Hospital See details
Medicare HMO Blue ValueRx (HMO) offers coverage for inpatient hospital services with no coinsurance, though the benefit is partially covered as non-Medicare-covered stays and room upgrades are not covered. Acute stays require a $350 daily copay for days 1 through 7, while psychiatric stays require a $275 daily copay for days 1 through 5, with no copay for subsequent covered days.
Outpatient Services See details
Medicare HMO Blue ValueRx (HMO) covers outpatient hospital and observation services with a $250 copay and no coinsurance, and ambulatory surgical center services with a $200 copay and no coinsurance. Outpatient substance abuse sessions require a $25 copay and 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 $55.00 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, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Medicare HMO Blue ValueRx (HMO) covers emergency services with a $140 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $40, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and a $105 copay per service.
Primary Care See details
Medicare HMO Blue ValueRx (HMO) covers primary care visits with a $10 copay and specialist visits with no copay to a $40 copay, both with no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, while opioid treatment is available with no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Medicare HMO Blue ValueRx (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals and kidney disease education. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, telemonitoring, home/bathroom safety devices, and counseling services.
Hearing Services See details
Medicare HMO Blue ValueRx (HMO) covers hearing services, including one annual routine hearing exam for a $10 copay and no coinsurance, plus unlimited hearing aid evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $699 and $999 for up to two devices per year, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Medicare HMO Blue ValueRx (HMO) covers one routine eye exam annually with a $10 to $40 copay, no coinsurance, and no deductible, though other eye exams are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $200 combined maximum every two years, excluding upgrades.
Dental Services See details
Medicare HMO Blue ValueRx (HMO) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, and routine exams, cleanings, and X-rays with no copay and no coinsurance. Services such as fluoride, restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, orthodontics, and other diagnostic or preventive services 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 is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Medicare HMO Blue ValueRx (HMO) covers dialysis services 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 covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Medicare HMO Blue ValueRx (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient lab services have no copay, diagnostic procedures range from a $0 to $10 copay, and outpatient X-rays have a $10 copay, while diagnostic radiological services carry a minimum $250 copay and therapeutic radiological services are not covered.
Home Health Services See details
Home Health Services are covered under the Medicare HMO Blue ValueRx (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare HMO Blue ValueRx (HMO) covers some Cardiac Rehabilitation Services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Medicare HMO Blue ValueRx (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 45 to 100, a $160 daily copay for days 21 to 44, and additional days beyond the standard 100 days are not covered.
Other Services See details
Medicare HMO Blue ValueRx (HMO) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other additional services are not covered under this benefit.
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