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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 $6750.00 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 drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using preferred pharmacies or preferred mail order services. For Tier 2 generic prescriptions, there is no copay for preferred mail orders, while preferred retail pharmacies charge a low copay starting at $4 for a one-month supply. For Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a flat 25% coinsurance across all pharmacy and mail order options. Standard pharmacies and standard mail order services are also available for generic tiers but come with higher copays, such as $15 for Tier 1 and $20 for Tier 2 one-month supplies. This structure helps you save money on your prescription drugs by utilizing preferred network pharmacies and mail-order delivery.
Additional Benefits
The Blue Medicare Essential Plus (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care physician visits and a $30 copay for specialist visits. For hospital care, inpatient stays require a $400 copay per day for the first few days with no copay thereafter, while outpatient hospital services range from no copay up to a $400 copay. Emergency care is available with a $130 copay, and urgent care costs $50 per visit, both with no coinsurance. This plan features no copay for routine eye and hearing exams, along with a $1,500 annual limit for preventive and comprehensive dental care at no copay. Additionally, members benefit from a $30 quarterly over-the-counter allowance, up to 12 free one-way transportation trips, and no copay for home health services. Most medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Blue Medicare Essential Plus (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $400 copay for days 1 to 6 of acute stays (no copay for days 7 and beyond) and a $400 copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). 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, including outpatient hospital care with a $0 to $400 copay and observation services with a $400 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Blue Medicare Essential Plus (HMO-POS) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this 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 trip, requiring prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to any health-related location with no copay or coinsurance, while plan-approved health-related location transfers are not covered.
Emergency Services See details
Blue Medicare Essential Plus (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which 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 a $100,000 limit with no coinsurance and copays ranging from $50 to $300.
Primary Care See details
Primary care benefits under Blue Medicare Essential Plus (HMO-POS) include primary care physician visits with no copay and no coinsurance, and specialist visits for a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, while podiatry is not covered, and only some chiropractic services are covered as routine and other chiropractic care 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 like annual physicals, kidney education, and fitness benefits. Sub-services not covered include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Blue Medicare Essential Plus (HMO-POS), featuring Medicare-covered hearing exams for a $20 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $999 for up to two aids per year, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids 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 $30 copay and no coinsurance. Eyewear is covered with no copay, though contact lenses require a 20% coinsurance with no copay, up to a combined $200 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Blue Medicare Essential Plus (HMO-POS), which features a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $1,500 annual limit. Services not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implants, 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 is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Essential Plus (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Essential Plus (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic therapeutic shoes, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and a coinsurance ranging from no coinsurance up to 20% from specified manufacturers, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Medicare Essential Plus (HMO-POS), with prior authorization required for all services. Lab services and outpatient X-rays feature no copay, diagnostic tests have a copay of $0 to $25 with no coinsurance, and diagnostic and therapeutic radiological services require copays starting at $0 and coinsurance starting at 20%.
Home Health Services See details
Home Health Services are covered by Blue Medicare Essential Plus (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Blue Medicare Essential Plus (HMO-POS), as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. While the overall benefit technically features no coinsurance, you will not have coverage for any of these rehabilitation services in practice.
Skilled Nursing Facility (SNF) See details
Blue Medicare Essential Plus (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare limit are not covered.
Other Services See details
Other services are partially covered by Blue Medicare Essential Plus (HMO-POS), featuring over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The plan provides a $30 quarterly OTC allowance and referral-required meals for chronic illnesses.
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