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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 2025, 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 New Mexico. This plan received an overall rating of 3 out of 5 stars in 2025.
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 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 Medicare Advantage Select (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your premium may be reduced.
Additional Benefits
The Blue Cross Medicare Advantage Select (HMO) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient hospital stays with a copay, outpatient services, partial hospitalization, ambulance and transportation, emergency services, and primary care, all with different copays or coinsurance amounts. Preventive services, like an annual physical exam, and some hearing and vision services, are covered with no copay. Additional benefits include dental services, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, cardiac rehabilitation, and skilled nursing facility care. Many services require a copay or coinsurance, with some services requiring prior authorization and a doctor's referral. The plan also includes over-the-counter items and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Blue Cross Medicare Advantage Select (HMO) plan. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $324 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Blue Cross Medicare Advantage Select (HMO) plan, including outpatient hospital services with a $275 copay, observation services with a $265 copay, ambulatory surgical center (ASC) services with a $175 copay, and outpatient substance abuse services with a $75 copay for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Select (HMO) plan, but requires prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Select (HMO) plan. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered with no copay, up to 12 one-way trips per year, while 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 under the Blue Cross Medicare Advantage Select (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, and Urgently Needed Services have a $20 copay. Worldwide Urgent Coverage also has a $120 copay, but Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (prior authorization and referral required), Occupational Therapy Services with a $40 copay (prior authorization and referral required), Physician Specialist Services with a $10 copay (prior authorization and referral required), and Mental Health Specialty Services with a $25 copay for individual and group sessions (prior authorization and referral required). Also covered are Physical Therapy and Speech-Language Pathology Services with a $40 copay (prior authorization and referral required), Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $40 copay (prior authorization and referral required). Podiatry Services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Select (HMO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services include Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams have a $50 copay, and routine hearing exams are covered with no copay for one exam per year. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a copay between $699 and $999 for all types, 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 and eyewear, with some services not usually covered by Medicare plans. Eye exams and contact lenses have no copay, while eyeglasses (lenses and frames) and upgrades are not covered. Routine eye exams and eyeglass lenses and frames are limited to one per year.
Dental Services See details
The Blue Cross Medicare Advantage Select (HMO) plan covers Medicare Dental Services with a $35 copay, and Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) with no copay. Other services are covered with varying coinsurance percentages, and Fluoride Treatment, Implant Services, and Orthodontics are not covered. The plan also covers Orthodontic Services with a maximum plan benefit of $1500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs, and Medicare Part B Insulin Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Select (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Blue Cross Medicare Advantage Select (HMO) plan. Durable medical equipment has a 20% coinsurance with prior authorization, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have a 0-20% coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $50, lab services with a $5 copay, diagnostic radiological services with a copay at most $250, therapeutic radiological services with a $30 copay, and outpatient X-ray services with a $10 copay. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Select (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor's referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Select (HMO) plan. For days 1-20 and 50-100, there is no copay, while days 21-49 have a $214 copay.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit. Over-the-Counter (OTC) Items have no copay, while the Meal Benefit also has no copay and requires a doctor's referral. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services 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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