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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)
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Drug Coverage
The Blue Cross and Blue Shield of Nebraska MA Core (HMO) prescription drug plan features an annual drug deductible of $400. Tier 1 preferred generic drugs offer excellent savings with no copay at standard pharmacies for all supply lengths, as well as no copay for a three-month supply filled through preferred mail order. Tier 2 generic drugs carry a $14 copay for a one-month supply at standard pharmacies, but you can avoid a copay entirely by ordering a three-month supply through preferred mail order. For higher-tier medications, Tier 3 preferred brands require a $47 monthly copay and Tier 4 non-preferred drugs require a $100 monthly copay at standard pharmacies, though both tiers offer slight discounts on three-month supplies through preferred mail order. Tier 5 specialty drugs are subject to a 28% coinsurance for a one-month supply across all standard pharmacy and mail-order options.
Additional Benefits
The Blue Cross and Blue Shield of Nebraska MA Core (HMO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialized medical needs, members pay a $35 copay for specialist visits, a $135 copay for emergency room services, and a $350 copay for outpatient hospital care. Inpatient hospital stays require a daily copay of $400 for the first four days of acute care, after which there is no copay for days five through ninety. This plan also includes essential supplemental benefits, featuring dental and vision coverage with no copay or coinsurance for preventive dental services and eyewear up to specified annual limits. Routine hearing exams are provided with no copay, while prescription hearing aids require a copay ranging from $395 to $1,595. Additionally, members can access a $300 annual fitness benefit and over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $400 for days 1 to 4 of acute stays and $420 for days 1 to 4 of psychiatric stays, followed by no copay for days 5 to 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO) with no coinsurance, featuring a $350 copay for outpatient hospital and observation services and a $300 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $35 copay and no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers partial hospitalization services. Under this plan, you will pay a $60.00 copay and no coinsurance for these covered services.
Ambulance and Transportation Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance per service, subject to prior authorization. The ambulance copay is not waived if you are admitted to the hospital, and transportation services are not covered.
Emergency Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers emergency services with a $135 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require 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) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services carry a $35 copay and no coinsurance. This partially covered benefit also includes chiropractic care with a $20 copay and no coinsurance, but podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO) with no copay and no coinsurance, including annual physicals, kidney disease education, remote access, and a fitness benefit up to $300 annually. Additional preventive benefits are partially covered; however, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO), which offers routine hearing exams and fitting evaluations annually with no copay and no coinsurance. Prescription hearing aids are covered up to two per year with no coinsurance and a copay ranging from $395.00 to $1,595.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) provides partially covered vision services, which include one routine eye exam per year for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, offering up to a $300 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) dental services are partially covered, offering Medicare-covered dental at a $35 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance up to a $1,200 annual maximum. Adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20% with no copay.
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, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. A 20% coinsurance applies to DME, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) diagnostic and radiological services are partially covered, as lab services are not covered. Covered diagnostic tests require prior authorization and have no coinsurance with copays ranging from no copay to $350, while radiological services require prior authorization and carry no copay for diagnostic radiology, a $25 copay for X-rays, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) covers cardiac rehabilitation services with no coinsurance, meaning some services are covered; however, standard cardiac rehabilitation ($35 copay), intensive cardiac rehabilitation ($60 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for PAD ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross and Blue Shield of Nebraska MA Core (HMO) 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 for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross and Blue Shield of Nebraska MA Core (HMO) provides partial coverage for other services, offering meals for chronic illnesses and over-the-counter items with no copay and no coinsurance. However, acupuncture and certain other supplemental services are not covered under this benefit.
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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