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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 $42.00. 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 the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay a $6 copay at a preferred pharmacy and a $12 copay at a standard pharmacy. Standard generic drugs have a $42 copay at a preferred pharmacy and a $47 copay at a standard pharmacy. Preferred brand drugs have a $95 copay at a preferred pharmacy and a $100 copay at a standard pharmacy. Non-preferred drugs have 27% coinsurance regardless of the pharmacy.
Additional Benefits
The Medicare HMO Blue ValueRx (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays for each. You'll pay copays for services like primary care visits, specialist visits, emergency services, and ambulance services, and there are no copays for many services, such as home health and lab services. Additionally, the plan covers hearing, vision, and dental services, with copays and limitations on some services. This plan also provides coverage for preventive services, including routine exams and some screenings, along with coverage for medical equipment, dialysis, and home infusion services. However, it's important to note that certain services, such as additional hours of care, therapeutic radiological services, and certain dental and vision upgrades, are not covered. The plan also does not cover many "other services" such as acupuncture, over-the-counter items, and EPSDT services, and there are some limitations on Cardiac Rehabilitation Services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. 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. Non-Medicare-covered stays and upgrades for both 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 services with a $200 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare HMO Blue ValueRx (HMO) plan, and requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Medicare HMO Blue ValueRx (HMO). Ground and Air Ambulance Services have a $250 copay, with no coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Medicare HMO Blue ValueRx (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a copay between $0 and $40, and Worldwide Emergency Services have a $105 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Under the Medicare HMO Blue ValueRx (HMO) plan, primary care physician services have a $10 copay, chiropractic services have a $20 copay, occupational therapy services have a $20 copay, and physician specialist services have a copay between $0 and $40. Mental health specialty services have a copay between $0 and $25 for individual sessions and a $25 copay for group sessions, while physical therapy and speech-language pathology services have a $20 copay. Other health care professional services have a copay between $10 and $40, while psychiatric services have a copay between $25 for both individual and group sessions. Additional telehealth benefits have a copay between $0 and $40, and the plan also covers opioid treatment program services.
Preventive Services See details
The Medicare HMO Blue ValueRx (HMO) plan covers preventive services including annual physical exams, health education, kidney disease education services, and other preventive services. Some services, such as in-home safety assessments, personal emergency response systems, and counseling services, are not covered. Wigs for hair loss related to chemotherapy and weight management programs are covered, with maximum benefit coverage amounts of $500 and $150 per year, respectively.
Hearing Services See details
Hearing services with the Medicare HMO Blue ValueRx (HMO) plan include routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but prescription hearing aids for inner, outer, 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 including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit coverage of $200 every two years, and upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams with a $40 copay, dental x-rays, and prophylaxis (cleaning), but fluoride treatment, restorative services, and orthodontics are not covered. Oral exams and prophylaxis (cleaning) are limited to two visits per year, while dental x-rays are limited to one set of bitewings twice per calendar year.
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 and 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 include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. 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, while Lab Services have no copay. Diagnostic Radiological Services have a copay of $250, and Outpatient X-Ray Services have a $10 copay, but 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, however, Medicare HMO Blue ValueRx (HMO) does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. There is a copay for some services, but the specific copay information is not available in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare HMO Blue ValueRx (HMO) plan, but require 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-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including 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. The plan does cover a meal benefit for a chronic illness.
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