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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 $93.00. 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. In the initial coverage phase, after the deductible, you'll pay a copay or coinsurance based on the drug tier and pharmacy used. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $10 copay at standard pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. This plan may have reduced premiums if you qualify for the low-income subsidy.
Additional Benefits
The Medicare HMO Blue FlexRx (HMO-POS) plan offers a range of benefits with varying costs. Hospital stays have copays, with outpatient services, including emergency and urgent care, also having set copays. The plan covers primary care, preventive, hearing, vision, and dental services, with different copays for each. Additional benefits include ambulance, home health, and skilled nursing facility services with specific copays or coinsurance, and coverage for some diagnostic and radiological services. Prescription hearing aids and eyewear are covered, with specific copays. The plan also offers a meal benefit for chronic illnesses, but excludes certain other services like cardiac rehabilitation and some home-based care.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $245 per day for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute, and no copay for days 1-60. Inpatient Hospital Psychiatric services are also covered, with a copay of $200 for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include all outpatient hospital services with a $200 copay, observation services with a $210 copay, ambulatory surgical center services with a $150 copay, outpatient substance abuse services with a $10 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 under the Medicare HMO Blue FlexRx (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare HMO Blue FlexRx (HMO-POS) plan. Medicare-covered ground and air ambulance services have a $200 copay, but there is 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 are covered, with a $140 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $60 with no coinsurance, while Worldwide Emergency Services have a $90 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits for the Medicare HMO Blue FlexRx (HMO-POS) plan include coverage for Primary Care Physician Services with a $10 copay, Chiropractic Services with a $20 copay (but not routine care), Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $0-$35 copay, Mental Health Specialty Services with a $0-$10 copay for individual sessions and a $10 copay for group sessions, and Physical Therapy and Speech-Language Pathology Services with a $15 copay. Other benefits include coverage for Other Health Care Professional services with a $10-$35 copay, Psychiatric Services with a $10 copay for individual and group sessions, Additional Telehealth Benefits with a $0-$35 copay, and Opioid Treatment Program Services.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services with prior authorization, annual physical exams, and additional preventive services. The plan also covers health education, wigs for hair loss related to chemotherapy (up to $500 per year), weight management programs (up to $150 per year), enhanced disease management, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit; however, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $10 copay, and prescription hearing aids with a copay between $699 and $999, while Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are covered. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Medicare HMO Blue FlexRx (HMO-POS) plan covers vision services, including eye exams with a copay of $10-$35. Eyewear is covered, with a combined maximum benefit of $200 every two years, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered as well. 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 treatment, orthodontic services, and other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For other drugs, there is 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. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 10% coinsurance and authorization required, Prosthetic Devices and Medical Supplies with a 10% coinsurance, and Diabetic Equipment with prior authorization. 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 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Medicare HMO Blue FlexRx (HMO-POS) plan. The plan 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, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require 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 for SNF 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 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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