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Blue Medicare Essential Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Essential Plus (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 Essential Plus (HMO-POS) in 2026, please refer to our full plan details page.
Blue Medicare Essential Plus (HMO-POS) is a HMO-POS plan offered by CuraCor Solutions Corp. available for enrollment in 2025 to people living in Select North Carolina Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Blue Medicare Essential Plus (HMO-POS) 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 Medicare Essential Plus (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 Essential Plus (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.
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 $615.00 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 $4900.00 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 Medicare Essential Plus (HMO-POS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, there is no copay when using preferred pharmacies or preferred mail order services. Tier 2 generics also offer no copay through preferred mail order, or a low copay starting at $4 for a one-month supply at preferred pharmacies. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, members pay a 25% coinsurance across all pharmacy types. Standard pharmacies and standard mail order options generally require higher copays, ranging from $3 to $60 depending on the drug tier and supply duration. Choosing preferred pharmacies and preferred mail order delivery is the most cost-effective way to manage prescription costs under this plan.
Additional Benefits
The Blue Medicare Essential Plus (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, annual physicals, and routine eye exams. Inpatient acute hospital stays require a $400 copay for days one through six and no copay thereafter, with no coinsurance required. Emergency room visits carry a $130 copay, which is waived if you are admitted within 48 hours, while specialist visits require a $20 copay. For dental and vision care, members benefit from no deductible and no copay for routine glasses and covered dental services up to a $1,500 annual maximum. Additionally, the plan covers up to 12 one-way health-related transportation trips per year and home health services with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Blue Medicare Essential Plus (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization. Acute stays require a $400 copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $400 copay for days 1 to 5 and no copay for days 6 to 90. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Medicare Essential Plus (HMO-POS) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copays. Outpatient hospital services incur a copay of $0 to $400 (including a $400 copay per stay for observation services), while outpatient substance abuse sessions have a $20 copay.
Partial Hospitalization See details
Blue Medicare Essential Plus (HMO-POS) covers partial hospitalization with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Blue Medicare Essential Plus (HMO-POS), with ground and air ambulance services requiring a $300 copay and no coinsurance. Transportation to any health-related location is covered with no copay and no coinsurance for up to 12 one-way trips per year, though plan-approved health-related location transportation is not covered.
Emergency Services See details
Blue Medicare Essential Plus (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 48 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 lifetime maximum with no coinsurance and copays of $130, $50, and $300 respectively.
Primary Care See details
Blue Medicare Essential Plus (HMO-POS) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies require copays of $15 to $20 with no coinsurance, while podiatry is not covered. Telehealth, opioid treatment, and other services have copays from $0 to $20 with no coinsurance, and while some chiropractic services are covered with a $15 copay and no coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under Blue Medicare Essential Plus (HMO-POS) with no copay and no coinsurance for covered services, including annual physicals, kidney disease education, fitness benefits, and in-home support. However, several services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Blue Medicare Essential Plus (HMO-POS), offering hearing exams with a $20 copay (or no copay for routine annual exams) and no coinsurance. Prescription hearing aids are covered up to two per year with a copay ranging from $499 to $999 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services covered by Blue Medicare Essential Plus (HMO-POS) feature no deductible, with routine eye exams and eyeglasses offered with no copay and no coinsurance. Contact lenses require a 20% coinsurance with no copay, while other eye exams have a $20 copay and no coinsurance.
Dental Services See details
Blue Medicare Essential Plus (HMO-POS) dental services are partially covered, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $1,500 annual maximum. Sub-services that are not covered include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Blue Medicare Essential Plus (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Blue Medicare Essential Plus (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Blue Medicare Essential Plus (HMO-POS) with no copay and a 20% coinsurance, except for diabetic supplies which range from no coinsurance to 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Medicare Essential Plus (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $25 copay for diagnostic tests, while radiological services carry a minimum 20% coinsurance and a $0 minimum copay, except for outpatient x-rays which have no copay.
Home Health Services See details
Home health services are covered under the Blue Medicare Essential Plus (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under Blue Medicare Essential Plus (HMO-POS), though only some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Medicare Essential Plus (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other services are partially covered by Blue Medicare Essential Plus (HMO-POS), offering over-the-counter items up to $49 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan.
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