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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 $5400.00 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, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic medications also offer no copay through preferred mail order, while preferred retail pharmacies charge a low copay starting at $4 for a one-month supply. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan charges a flat 25% coinsurance regardless of the pharmacy type you choose. Standard pharmacies and standard mail-order services are available but carry higher copays, such as $15 for Tier 1 and $20 for Tier 2 drugs. This plan provides cost-effective prescription options, especially when utilizing preferred network pharmacies and mail-order services.
Additional Benefits
The Blue Medicare Essential Plus (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits and a $25 copay for specialist consultations. Inpatient hospital stays require a $400 daily copay for the first five to six days, followed by no copay for the rest of your stay, while outpatient hospital services range from no copay up to a $400 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted within 48 hours, while urgent care services require a $50 copay. Members also receive routine vision, hearing, and preventive dental services with no copay, plus up to $1,500 annually for covered dental care. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, while home health services and up to 12 health-related one-way trips per year are provided with no copay. Additionally, the plan features no copay for lab tests and outpatient X-rays, alongside a $40 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Blue Medicare Essential Plus (HMO-POS) covers inpatient hospital care with no coinsurance, requiring a $400 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and services such as 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, featuring a $0 to $400 copay for outpatient hospital services and a $400 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay, while outpatient substance abuse services require a $25 copay per session.
Partial Hospitalization See details
Blue Medicare Essential Plus (HMO-POS) covers partial hospitalization services with a $60 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Blue Medicare Essential Plus (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance per service. Transportation services are partially covered, providing up to 12 one-way trips per year to any health-related location with no copay and no coinsurance, while plan-approved health-related location trips are not covered.
Emergency Services See details
Blue Medicare Essential Plus (HMO-POS) emergency services are covered with a $130 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $100,000 with no coinsurance and copays of $130, $50, and $300 respectively.
Primary Care See details
Blue Medicare Essential Plus (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $15 copay and no coinsurance, while podiatry is not covered, and for chiropractic services, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Blue Medicare Essential Plus (HMO-POS) with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and diabetes self-management training. Specific sub-services not covered under this plan include health education, in-home safety assessments, medical nutrition therapy, weight management programs, and therapeutic massage.
Hearing Services See details
Hearing services are partially covered by Blue Medicare Essential Plus (HMO-POS), featuring Medicare-covered exams for a $25 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a $499 to $999 copay for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Blue Medicare Essential Plus (HMO-POS) covers vision services with no deductible, offering routine eye exams with no copay and no coinsurance, and contact lens exams for a $25 copay and no coinsurance. Covered eyewear features no copay and no coinsurance for eyeglasses, and no copay with a 20% coinsurance for contact lenses, up to a combined annual maximum of $200.
Dental Services See details
Blue Medicare Essential Plus (HMO-POS) provides partially covered dental services up to a $1,500 annual maximum, requiring a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive and comprehensive benefits. While exams, cleanings, x-rays, fluoride, and select surgical or restorative services are covered, this plan does not cover other diagnostic or preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Medicare Essential Plus (HMO-POS) with no copay, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 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
Blue Medicare Essential Plus (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copay and a required prior authorization. A 20% coinsurance applies to most items, though diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Medicare Essential Plus (HMO-POS) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Outpatient diagnostic procedures and tests have a copay ranging from $0 to $25 with no coinsurance, while diagnostic and therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Blue Medicare Essential Plus (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Medicare Essential Plus (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, though standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for PAD services are not covered in practice. Among these, pulmonary rehabilitation carries a $15 copay and SET for PAD carries a $25 copay, while the remaining services have no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Medicare Essential Plus (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day inpatient 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 Medicare-covered limit are not covered.
Other Services See details
Blue Medicare Essential Plus (HMO-POS) partially covers other services, providing over-the-counter items up to $40 every three months and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered under this plan, and a referral is required to receive the meal benefit.
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