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Blue Cross Blue Shield Nebraska MA Core (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Blue Shield Nebraska MA Core (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Blue Shield Nebraska MA Core (HMO) in 2025, please refer to our full plan details page.
Blue Cross Blue Shield Nebraska MA Core (HMO) is a HMO plan offered by Blue Cross Blue Shield of Nebraska available for enrollment in 2025 to people living in Omaha/Lincoln Metro Area and Central Nebraska. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Blue Cross Blue Shield Nebraska MA Core (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 Blue Cross Blue Shield Nebraska MA Core (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 Blue Cross Blue Shield Nebraska MA Core (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 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 Blue Cross Blue Shield Nebraska MA Core (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. The copay depends on the drug tier and the pharmacy you use. For example, the copay for a standard generic drug is $14.00, while the copay for a preferred brand drug is $100.00. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Blue Cross Blue Shield Nebraska MA Core (HMO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, while outpatient services, including doctor visits, have copays ranging from $20-$350. Preventive services, hearing exams, and home health services are covered with no copay, and there is also coverage for vision and dental services with a copay. Additional benefits include ambulance and emergency services with copays, as well as coverage for hearing aids and eyewear. The plan also includes coverage for home infusion services, dialysis services, and medical equipment with varying coinsurance rates. Other services like OTC items and a meal benefit for chronic illness are also offered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $400 copay for days 1-4 of Inpatient Hospital-Acute stays and a $420 copay for days 1-4 of Inpatient Hospital Psychiatric stays; days 5-90 have no copay for either service. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a copay of $350.00. Ambulatory Surgical Center (ASC) Services are covered with a $300 copay, while outpatient substance abuse services have a copay of $35.00. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan, with a $60 copay. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. Ground and Air Ambulance Services each have a $350 copay, with no coinsurance. 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 by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. Emergency services have a $125 copay, and urgently needed services have a $55 copay, with no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay, with no coinsurance.
Primary Care See details
The Blue Cross Blue Shield Nebraska MA Core (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while occupational therapy, physician specialist services, individual and group mental health and psychiatric sessions, and opioid treatment program services have a $35 copay. Other health care professional services have a copay between $0 and $35, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $55. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other preventive services, are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. Some additional preventive services, such as Health Education, In-Home Safety Assessment, and Medical Nutrition Therapy, are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered with a copay between $395 and $1595, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $35 copay, and eyewear with a combined maximum benefit of $300 per year. The plan also covers one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services. Other services include oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 visits per year), fluoride treatment (1 per year), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices and Medical Supplies also have a 20% coinsurance, while Diabetic Supplies have a 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Blue Cross Blue Shield Nebraska MA Core (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $30 and $350, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at least $195, Therapeutic Radiological Services have a coinsurance of 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan, but 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. The copay for this service is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan, but require prior authorization. You will have no copay for days 1-20 and days 54-100, and a $186 copay for days 21-53.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a $60 benefit every three months, and a meal benefit for chronic illness, but acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered. The OTC benefit includes nicotine replacement therapy and naloxone coverage.
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