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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 depending on the drug tier and pharmacy you use. For example, you will pay a $14 copay for preferred generic drugs at standard, preferred, and mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The Blue Cross Blue Shield Nebraska MA Core (HMO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient services, with copays ranging from $35 to $420 depending on the service. It also covers emergency services, primary care, preventive services, hearing, vision, and dental services with copays or no copays. Additional benefits include home health services with no copay, and skilled nursing facility services with no copay for most days. The plan also covers medical equipment, and diagnostic and radiological services. However, some services like acupuncture, orthodontic services, and additional preventive services are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered under the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. For Inpatient Hospital-Acute, you will pay a $400 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you will pay a $420 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient Hospital Services and Observation Services have a $350 copay, Ambulatory Surgical Center (ASC) Services have a $300 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay between $35.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. You will have a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $350 copay for both ground and air ambulance services, and 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. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Blue Cross Blue Shield Nebraska MA Core (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $35 copay, other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $35 copay; podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, with no copay or coinsurance. Additional preventive services such as health education, in-home safety assessment, and weight management programs are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, both once per year. Prescription hearing aids (all types) are covered with a copay between $395 and $1595, up to two per year. 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 Blue Cross Blue Shield Nebraska MA Core (HMO) plan covers vision services, including routine eye exams with a $35 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum plan benefit of $300 every year, along with upgrades.
Dental Services See details
Dental services include a $35 copay for Medicare dental services. Other services include oral exams (2 visits per year) and dental x-rays (1 per year), and other diagnostic, preventive, restorative, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, and implant services, all covered with no copay. Orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance, and Diabetic Supplies have between 0% and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Blue Shield Nebraska MA Core (HMO) plan. Diagnostic Procedures/Tests have a copay between $30 and $350, while Lab Services are not covered. Diagnostic Radiological Services have a copay of $195, Therapeutic Radiological Services have a 20% coinsurance, 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 and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Blue Shield Nebraska MA Core (HMO), but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some services; however, the specific copay amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. You will have no copay for days 1-20 and days 54-100, but a $186 copay for days 21-53.
Other Services See details
The Blue Cross Blue Shield Nebraska MA Core (HMO) plan does not cover acupuncture, 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. The plan covers over-the-counter items with a maximum benefit of $60 every three months, and meal benefits for chronic illnesses.
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