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Blue Cross and Blue Shield of Nebraska MA Core (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross and Blue Shield of 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 and Blue Shield of Nebraska MA Core (HMO) 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.
Blue Cross and Blue Shield of Nebraska MA Core (HMO) is a HMO plan offered by Sapphire Edge, Inc. available for the 2026 plan year to people living in Omaha/Lincoln Metro Area and Central Nebraska. CMS star rating not available for 2026.
It's important to know that Blue Cross and Blue Shield of 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 and Blue Shield of 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 and Blue Shield of 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.
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 $400.00 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.
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:
Sign up for Blue Cross and Blue Shield of Nebraska MA Core (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Blue Cross and Blue Shield of Nebraska MA Core (HMO) plan features a $400 drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay at standard pharmacies, while preferred mail-order options also offer no copay for a three-month supply. Tier 2 generic drugs cost $14 for a one-month supply at standard pharmacies, with no copay required for a three-month supply when using preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply, and Tier 4 non-preferred drugs cost $100 for a one-month supply. Specialty drugs in Tier 5 require a 28% coinsurance for a one-month supply across standard pharmacies and mail-order services. Utilizing preferred mail-order services for three-month supplies generally provides the lowest out-of-pocket costs for prescription drugs under this plan.
Additional Benefits
The Blue Cross and Blue Shield of Nebraska MA Core (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits or preventive services. Specialist visits require a $35 copay, while emergency services are covered with a $135 copay and no coinsurance. For inpatient care, members pay a $400 daily copay for days 1 to 4 of acute hospital stays, with no copay for subsequent days and no coinsurance. This plan also features valuable supplemental benefits, including preventive dental care and routine hearing exams with no copay. Eyewear is covered with no copay up to a $300 annual maximum, and members receive a $50 quarterly allowance for over-the-counter items. Additionally, home health services are covered with no copay and no coinsurance, helping members manage their health needs affordably.
Inpatient Hospital See details
Inpatient hospital services are covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO) with no coinsurance, requiring a $400 daily copay for days 1 to 4 of acute stays and a $420 daily copay for days 1 to 4 of psychiatric stays, followed by no copay for subsequent days. Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $350 copay and ambulatory surgical center services for a $300 copay. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. This benefit provides affordable, structured outpatient mental health care with predictable out-of-pocket costs.
Ambulance and Transportation Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers emergency services with a $135 copay and no coinsurance, with the copay waived if admitted to the hospital within three days. Urgently needed services are covered with a $55 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $135 copay and no coinsurance.
Primary Care See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) provides partially covered primary care benefits, as podiatry services are not covered. All covered services have no coinsurance, featuring no copay for primary care visits, a $20 copay for chiropractic care, a $35 copay for specialists, therapies, psychiatric, and mental health services, and copays ranging from $0 to $55 for telehealth.
Preventive Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers preventive services with no copay and no coinsurance, though additional preventive benefits are only partially covered. Covered services include annual physical exams, kidney disease education, and a $300 annual fitness benefit, while health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing Services are covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO), offering annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $395.00 to $1,595.00, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) offers partially covered vision services, which include one routine eye exam per year for a $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $300 combined annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO), featuring a $35 copay and no coinsurance for Medicare-covered dental care. Other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $1,200 annual maximum, though adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers medical equipment with no copay, though prior authorization may be required for certain items. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO), as lab services are not covered under this benefit. Diagnostic tests require prior authorization and have no coinsurance with a copay of up to $350, while radiological services feature no copay for diagnostic imaging, a 20% coinsurance for therapeutic services, and a $25 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Blue Cross and Blue Shield of Nebraska MA Core (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO) with no coinsurance, but some services are covered while cardiac rehabilitation ($35 copay), intensive cardiac rehabilitation ($60 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 61 to 100, a $214 daily copay applies for days 21 to 60, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO), featuring a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. While OTC items are covered up to $50 every three months, acupuncture is not covered.
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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