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Blue Cross Medicare Advantage Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Select (HMO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Select (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in NM HMO. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Select (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 Medicare Advantage Select (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 Medicare Advantage Select (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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $450.00 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 $4200.00 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 Medicare Advantage Select (HMO) plan features an annual prescription drug deductible of $450. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred retail pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail order, copays start as low as $5 for Tier 1 and $6 for Tier 2 drugs. Higher-tier medications are subject to coinsurance, with Tier 3 preferred brands costing 16% at preferred pharmacies and 20% at standard pharmacies. Tier 4 non-preferred drugs have a 38% coinsurance at preferred locations and 42% at standard locations, while Tier 5 specialty drugs require a flat 27% coinsurance for a one-month supply. Utilizing preferred network pharmacies and mail-order services offers the most significant savings under this plan.
Additional Benefits
The Blue Cross Medicare Advantage Select (HMO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. Specialist visits require a $20 copay with no coinsurance, while emergency room visits have a $120 copay that is waived if you are admitted. For hospital stays, inpatient acute care requires a $350 daily copay for the first six days with no coinsurance, and outpatient hospital services carry a $300 copay. This plan also provides valuable supplemental benefits, including routine eye and hearing exams with no copay, alongside a $100 annual eyewear allowance and affordable prescription hearing aid copays. Preventive and comprehensive dental care features no copay and 0% to 20% coinsurance up to a $1,000 yearly limit. Additionally, members receive an $80 allowance every three months with no copay or coinsurance for over-the-counter items, and home health services are fully covered with no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Select (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 6 of acute stays and a $324 daily copay for days 1 to 5 of psychiatric stays, with no copays for subsequent covered days. Prior authorization and referrals are required, and some services—including upgrades, non-Medicare-covered stays, and additional psychiatric days—are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Select (HMO) covers outpatient services with no coinsurance, including outpatient hospital services for a $300 copay, observation services for a $275 copay per stay, and ambulatory surgical center services for a $250 copay. Outpatient substance abuse services require a $75 copay with no coinsurance, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Select (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Blue Cross Medicare Advantage Select (HMO) with a $300 copay and no coinsurance for ground services, and a 20% coinsurance with no copay for air services, both requiring prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Select (HMO) covers emergency services with a $120 copay (waived if admitted within 3 days) and urgent care with a $20 copay, both featuring no coinsurance. Worldwide emergency and urgent services are partially covered with a $120 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care and telehealth services are covered by Blue Cross Medicare Advantage Select (HMO) with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Physical, occupational, and speech therapy cost a $40 copay and no coinsurance, mental health and psychiatric services have a $25 copay and no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Select (HMO) covers preventive services, including annual physical exams, fitness benefits, and kidney disease education, with no copay and no coinsurance. However, this benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, safety devices, and counseling are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Select (HMO) covers hearing services, featuring Medicare-covered exams for a $50 copay and routine exams or fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance, although OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Select (HMO) provides partially covered vision services with no copays or coinsurance, including one routine eye exam annually and a $100 yearly allowance for contact lenses, eyeglass lenses, and eyeglass frames. Other eye exam services, eyeglasses (lenses and frames) packages, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Blue Cross Medicare Advantage Select (HMO), featuring Medicare-covered dental services for a $35 copay and no coinsurance, and preventive and comprehensive services for no copay and 0% to 20% coinsurance up to a $1,000 yearly limit. However, other diagnostic dental services, fluoride treatments, other preventive services, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Select (HMO) with no copay, though prior authorization and step therapy may be required. Under this benefit, Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Select (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Select (HMO) with no copays and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes. Diabetic supplies have a coinsurance ranging from no coinsurance to 20% coinsurance, and prior authorization is required for all covered medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Select (HMO) with no coinsurance, though prior authorization and referrals are required. Members will pay no copay to a $50 copay for diagnostic tests, a $5 copay for lab services, a $10 copay for X-rays, no copay for some diagnostic radiology, and a minimum $30 copay for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Select (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive this care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Medicare Advantage Select (HMO) with no coinsurance, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These non-covered services require prior authorization and referrals, and they carry copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Select (HMO) with no coinsurance, offering no copay for days 1 through 20 and days 50 through 100, and a $218 daily copay for days 21 through 49. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and both prior authorization and referrals are required.
Other Services See details
Blue Cross Medicare Advantage Select (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to an $80 limit every three months that carries forward if unused. However, acupuncture, meal benefits, and naloxone are not covered.
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Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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