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Blue Medicare Medical Only (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Medical Only (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Medical Only (HMO-POS) in 2025, please refer to our full plan details page.
Blue Medicare Medical Only (HMO-POS) is a HMO-POS plan offered by Blue Cross and Blue Shield of North Carolina available for enrollment in 2025 to people living in Select North Carolina Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Blue Medicare Medical Only (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Medicare Medical Only (HMO-POS).
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 Medicare Medical Only (HMO-POS), 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 $50.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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:
Sign up for Blue Medicare Medical Only (HMO-POS)
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Drug Coverage
Prescription drugs are not covered by Blue Medicare Medical Only (HMO-POS).
Additional Benefits
The Blue Medicare Medical Only (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. Emergency services, primary care, and preventive services are covered, with some services having no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays and coinsurance amounts. Additionally, this plan covers ambulance services, home health services, and medical equipment, with applicable copays and coinsurance. Other benefits include home infusion, dialysis, and skilled nursing facility services. The plan also offers a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $295 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $275 copay, observation services with no copay, ambulatory surgical center services with a $225 copay, individual and group sessions for outpatient substance abuse with a copay between $25 and $25, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Medicare Medical Only (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Medicare Medical Only (HMO-POS) plan, with a $250 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to any health-related location are covered with a $0 copay, and no coinsurance, with a limit of 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $55 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Blue Medicare Medical Only (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $25 copay. Specialist visits cost $25, while mental health and psychiatric individual and group sessions have a $25 copay. Physical therapy and speech-language pathology services have a $25 copay. Other health care professionals have a copay between $0 and $25, and opioid treatment program services have a $10 copay. Additional telehealth benefits have a copay between $0 and $25. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services, including Personal Emergency Response System, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, with no copay. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, 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, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams are covered with no copay for 1 visit per year. Fitting/Evaluation for Hearing Aids has no copay. Prescription hearing aids are partially covered, with prescription hearing aids (all types) having a copay between $699 and $999 for 2 visits per year, 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
The Blue Medicare Medical Only (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with a 20% coinsurance for contact lenses and no copay for eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay, and other eye exam services have a $25 copay.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 copay, oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery with no copay. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. There is a maximum plan benefit of $2,000 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. This plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Medical Only (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Blue Medicare Medical Only (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0-20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Medicare Medical Only (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20% and copays of at most $300 and $60, respectively. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Medical Only (HMO-POS) 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 not covered by the Blue Medicare Medical Only (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Medical Only (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20 and days 61-100, and a $214 copay for days 21-60. Additional days beyond what Medicare covers, and non-Medicare-covered stays, are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and meal benefits, with OTC items having no copay and a maximum benefit coverage amount of $100 every three months. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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