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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Medicare HMO Blue FlexRx (HMO-POS) is a HMO-POS plan offered by BCBS of Massachusetts HMO Blue, Inc. available for the 2026 plan year 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 $129.00. 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
Health deductible: information not available.
This plan has a $260.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4100.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4100.00 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 $5750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5750.00 for out-of-network covered services, the plan will pay 100% of out-of-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 an annual drug deductible of $260. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies and through standard mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at preferred pharmacies and standard mail order. For Tier 3 preferred brands and Tier 4 non-preferred drugs, one-month copays at preferred pharmacies are $42 and $95, respectively. Standard pharmacies charge slightly higher copays, such as $47 for Tier 3 and $100 for Tier 4 drugs. Tier 5 specialty drugs require a 29% coinsurance across all pharmacy types for a one-month supply.
Additional Benefits
The Medicare HMO Blue FlexRx (HMO-POS) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for inpatient hospital stays, outpatient services, and emergency care. Primary care doctor visits require a low $10 copay, while specialist visits range from no copay to a $35 copay. For hospitalizations, patients pay no copay after the initial days of a stay, and routine home health services are fully covered with no copay or coinsurance. This plan also includes key preventive and supplemental benefits, featuring no copay for annual physicals and routine preventive dental cleanings. Routine vision and hearing exams are available with low copays, and the plan provides up to a $200 eyewear allowance every two years with no copay or deductible. For specialized care, durable medical equipment is covered with a 10% coinsurance and no copay, while dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Medicare HMO Blue FlexRx (HMO-POS) covers inpatient hospital services with no coinsurance, featuring a $245 daily copay for days 1-7 of acute care and a $200 daily copay for days 1-5 of psychiatric care, with no copay for subsequent days. Prior authorization is required, and upgrades or 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
Medicare HMO Blue FlexRx (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access 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, which is waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Medicare HMO Blue FlexRx (HMO-POS) with a $140 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services feature no copay to a $60 copay 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) covers primary care physician services for a $10 copay and specialist visits for a $0 to $35 copay, both with no coinsurance. Additional benefits like physical therapy, telehealth, and mental health services have copays ranging from no copay to $35 with no coinsurance, while podiatry is not covered and chiropractic benefits are only partially covered because routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Medicare HMO Blue FlexRx (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management. However, additional preventive benefits are only partially covered, excluding services such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, alternative therapies, and home safety modifications.
Hearing Services See details
Hearing services are partially covered by Medicare HMO Blue FlexRx (HMO-POS), featuring routine hearing exams for a $10 copay and no coinsurance. Prescription hearing aids are covered with a $699 to $999 copay and no coinsurance, but OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription models, are not covered.
Vision Services See details
Medicare HMO Blue FlexRx (HMO-POS) partially covers vision services, as other eye exam services and eyewear upgrades are not covered. Routine eye exams require a $10.00 to $35.00 copay and no coinsurance with no deductible, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $200.00 maximum benefit every two years.
Dental Services See details
Medicare HMO Blue FlexRx (HMO-POS) partially covers dental services, offering Medicare-covered dental care for a $35.00 copay and no coinsurance. Preventive services like oral exams, cleanings, and x-rays are available with no copay and no coinsurance, while other treatments such as fluoride, restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Medicare HMO Blue FlexRx (HMO-POS) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Medicare HMO Blue FlexRx (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under Medicare HMO Blue FlexRx (HMO-POS) with no copay and a 10% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Medicare HMO Blue FlexRx (HMO-POS) with no coinsurance, though therapeutic radiological services are not covered. Covered services require prior authorization and include lab services with no copay, outpatient X-rays for a $10 copay, diagnostic procedures with a $0 to $10 copay, and diagnostic radiological services with a minimum $200 copay.
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 cardiac rehabilitation services with no coinsurance, but only some services are covered. 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 FlexRx (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. Patients pay no copay for days 1 to 20 and days 45 to 100, a $140 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 FlexRx (HMO-POS) partially covers other services, featuring a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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