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Medicare HMO Blue FlexRx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare HMO Blue FlexRx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare HMO Blue FlexRx (HMO-POS) in 2025, please refer to our full plan details page.
Medicare HMO Blue FlexRx (HMO-POS) is a HMO-POS 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 FlexRx (HMO-POS) 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 FlexRx (HMO-POS).
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 FlexRx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $73.00. 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 $260.00 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 $5750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5750.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $4100.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5750.00 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 FlexRx (HMO-POS) plan has a $260 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), you will pay no copay for Part D drugs.
Additional Benefits
The Medicare HMO Blue FlexRx (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays depending on the service. The plan also covers ambulance services, emergency services, and many primary care services, all with copays. Preventive services, home health, and some vision services have no copay, while dental services have a $35 copay. The plan also covers hearing exams and hearing aids, with copays, and offers coverage for medical equipment and diagnostic services, with coinsurance or copays. Other benefits include partial hospitalization, skilled nursing facility stays, and dialysis services, each with specific cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $245 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are covered, with a copay of $200 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as is Non-Medicare-covered stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $200 copay, observation services have a $210 copay, ambulatory surgical center services have a $150 copay, and outpatient substance abuse services have a $10 copay for both individual and group sessions. Outpatient blood services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare HMO Blue FlexRx (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $200 copay, with no coinsurance, and the copay is waived if admitted to the hospital; however, 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 under the Medicare HMO Blue FlexRx (HMO-POS) plan. Emergency Services have a $140 copay, Urgently Needed Services have a copay between $0 and $60, and Worldwide Emergency Services have a $90 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a $10 copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a copay between $0 and $35, Mental Health Specialty Services with varying copays depending on the service, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services; routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Medicare HMO Blue FlexRx (HMO-POS) plan covers preventive services, including annual physical exams, with no copay, as well as additional services like wigs for hair loss (up to $500 per year) and weight management programs (up to $150 per year). Some services like in-home safety assessments and counseling services are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $10 copay, and prescription hearing aids with a copay between $699 and $999, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered with no limit. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $10-$35, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $200 every two years, and upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and prophylaxis (cleaning), each with a $35 copay. Fluoride treatments, 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. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare HMO Blue FlexRx (HMO-POS) plan, but require prior authorization. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 10% coinsurance and Prosthetics/Medical Supplies with 10% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Medicare HMO Blue FlexRx (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a copay of $200, 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 FlexRx (HMO-POS) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare HMO Blue FlexRx (HMO-POS) plan. Specifically, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, for days 21-44, the copay is $140, and for days 45-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are partially covered by the Medicare HMO Blue FlexRx (HMO-POS) plan. Acupuncture, Over-the-Counter (OTC) 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 does cover a Meal Benefit for a chronic illness.
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