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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 2026, 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 4.5 out of 5 stars in 2026.
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 $118.00. 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 features an annual prescription drug deductible of $260. For Tier 1 preferred generic drugs, members enjoy no copay when using a preferred pharmacy or standard mail order service, while standard pharmacies charge a $6 copay for a one-month supply. Tier 2 generic medications cost as little as a $5 copay for a one-month supply at preferred pharmacies and standard mail order, or $10 at standard pharmacies. For higher-tier prescriptions, Tier 3 preferred brand drugs carry a $42 copay and Tier 4 non-preferred drugs carry a $95 copay for a one-month supply at preferred pharmacies. Standard pharmacy copays are slightly higher, costing $47 for Tier 3 and $100 for Tier 4 one-month supplies. Specialty medications in Tier 5 require a 29% coinsurance for a one-month supply across all pharmacy options.
Additional Benefits
The Medicare HMO Blue FlexRx (HMO-POS) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring no coinsurance for many core services. Patients enjoy no copay for preventive services, routine dental exams, and home health services, alongside a low $10 copay for primary care provider visits. For emergency care and inpatient hospital stays, the plan utilizes flat copayments, such as a $140 copay for emergency room visits and a $245 daily copay for the first seven days of acute hospital stays. Specialty benefits under this plan include routine hearing and vision exams with copays ranging from $10 to $35, plus a $200 eyewear allowance every two years. Skilled nursing facility stays feature no copay for days 1 through 20, while durable medical equipment requires a 10% coinsurance with no copay. Although the plan covers essential medical and diagnostic services with low or no copayments, certain benefits like transportation and over-the-counter items are not covered.
Inpatient Hospital See details
Medicare HMO Blue FlexRx (HMO-POS) offers partially covered inpatient hospital care with no coinsurance, requiring a $245 daily copay for days 1-7 of acute stays and a $200 daily copay for days 1-5 of psychiatric stays, followed by no copay for additional days. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital services, a $210 copay per stay for observation services, and a $150 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $10 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Medicare HMO Blue FlexRx (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers emergency services with a $140 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services feature a copay ranging from no copay to $60 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $90 copay and no coinsurance.
Primary Care See details
Medicare HMO Blue FlexRx (HMO-POS) primary care benefits feature no coinsurance for all covered services, with copays ranging from no copay up to $35, including a $10 copay for primary care provider visits. Services such as physical therapy, specialist visits, and mental health care are covered, while chiropractic and podiatry services are not covered.
Preventive Services See details
Medicare HMO Blue FlexRx (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered services like annual physical exams and cardiovascular screenings. 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 safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Medicare HMO Blue FlexRx (HMO-POS), featuring a $10 copay and no coinsurance for one routine annual hearing exam and unlimited fitting evaluations. Up to two prescription hearing aids are covered each year with no coinsurance and a copay ranging from $699 to $999, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Medicare HMO Blue FlexRx (HMO-POS) partially covers vision services, featuring routine eye exams with a $10 to $35 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay and no coinsurance up to a $200 limit every two years, but upgrades are not covered.
Dental Services See details
Medicare HMO Blue FlexRx (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $35 copay and no coinsurance, as well as routine exams, cleanings, and x-rays with no copay and no coinsurance. Restorative services, endodontics, periodontics, prosthodontics, implants, orthodontics, oral surgery, and fluoride treatments are not covered.
Home Infusion bundled Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization. Associated Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare HMO Blue FlexRx (HMO-POS) partially covers medical equipment, providing durable medical equipment and prosthetics with no copay and 10% coinsurance. Diabetic equipment features 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 under Medicare HMO Blue FlexRx (HMO-POS) with no coinsurance, though prior authorization is required. Covered benefits include lab services with no copay, diagnostic tests with a $0 to $10 copay, outpatient X-rays for $10, and diagnostic radiology with a minimum $200 copay, while therapeutic radiological services are not covered.
Home Health Services See details
Home Health Services are covered by Medicare HMO Blue FlexRx (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers some cardiac rehabilitation services with a $15 copayment and no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Medicare HMO Blue FlexRx (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, as additional days beyond the standard 100-day Medicare benefit period are not covered. For covered SNF stays, there is no copay for days 1 through 20 and days 45 through 100, while a $140 daily copay applies for days 21 through 44.
Other Services See details
Other Services under the Medicare HMO Blue FlexRx (HMO-POS) plan are partially covered, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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