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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 $7450.00 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, beneficiaries enjoy no copay when utilizing preferred pharmacies or preferred mail order services. Tier 2 generic medications also feature no copay through preferred mail order, while preferred retail pharmacies charge a low $4 copay for a one-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a consistent 25% coinsurance across all pharmacy and mail order options. Standard pharmacies and standard mail order services are also available, though they carry higher copays such as $15 for Tier 1 and $20 for Tier 2 single-month fills. This plan structure allows members to lower their out-of-pocket prescription expenses by choosing preferred network pharmacies.
Additional Benefits
The Blue Medicare Essential Plus (HMO-POS) plan offers robust coverage featuring no copay and no coinsurance for primary care visits, preventive care, home health services, and routine vision and dental exams. Members also enjoy no copays for cardiac rehabilitation, the first 20 days of skilled nursing facility care, and up to 12 one-way transportation trips per year. Specialist visits, urgent care, and physical therapy are also highly affordable with low copays ranging from $20 to $40 and no coinsurance. For emergency and hospital care, the plan features a $115 emergency room copay and a $400 daily copay for the first six days of inpatient hospital stays. Diagnostic services and medical equipment have no copays, though durable medical equipment and dialysis require a 20% coinsurance. Additionally, prescription hearing aids and dental services are partially covered to help keep your out-of-pocket expenses manageable.
Inpatient Hospital See details
Blue Medicare Essential Plus (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $400 daily copay for days 1 to 6 of acute stays (no copay thereafter) and days 1 to 5 of psychiatric stays (no copay for days 6 to 90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
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, a $400 copay per stay for observation services, and a $40 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are also covered with no 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
Ambulance and transportation services are covered under Blue Medicare Essential Plus (HMO-POS), with ground and air ambulance services requiring a $300 copay and no coinsurance. The plan also covers up to 12 one-way transportation trips per year to any health-related location with no copay and no coinsurance.
Emergency Services See details
Blue Medicare Essential Plus (HMO-POS) covers emergency services with a $115 copay (waived if admitted within 48 hours) and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum benefit with no coinsurance and copays of $115, $40, and $300 respectively.
Primary Care See details
Blue Medicare Essential Plus (HMO-POS) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $40 copay with no coinsurance. Physical, occupational, and speech therapy services are covered with a $20 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Medicare Essential Plus (HMO-POS) offers preventive services with no copay and no coinsurance, including annual physical exams, fitness benefits, and glaucoma screenings. However, these additional preventive services are only partially covered, excluding 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, home safety modifications, and counseling.
Hearing Services See details
Blue Medicare Essential Plus (HMO-POS) provides partially covered hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to two per year with a copay between $499 and $999 and no coinsurance, while OTC hearing aids and inner ear, outer ear, or over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Blue Medicare Essential Plus (HMO-POS) with no deductible, including routine eye exams with no copay and no coinsurance, and other eye exams for a $0 to $40 copay and no coinsurance. Eyeglasses and upgrades have no copay and no coinsurance, while contact lenses feature no copay but require a 20% coinsurance, up to a combined $200 annual limit.
Dental Services See details
Blue Medicare Essential Plus (HMO-POS) offers partially covered dental services with a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $1,500 annual maximum. Non-covered services include other diagnostic dental, other preventive dental, 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 may apply. Covered Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy and radiation drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under Blue Medicare Essential Plus (HMO-POS) with no copay and a 20% coinsurance. This benefit ensures access to necessary dialysis treatments with clear, predictable out-of-pocket costs.
Medical Equipment See details
Blue Medicare Essential Plus (HMO-POS) covers medical equipment with no copay, though prior authorization is required. Patients will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies range from no coinsurance up to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Medicare Essential Plus (HMO-POS) with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $25 copay for tests, while 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. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Blue Medicare Essential Plus (HMO-POS) with no copay and no coinsurance, but in practice only some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with additional days beyond Medicare limits not covered.
Other Services See details
Blue Medicare Essential Plus (HMO-POS) partially covers other services, offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Covered over-the-counter items have a maximum benefit of $25 every three months, and the meal benefit requires a referral.
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