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Blue Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Enhanced (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 Enhanced (HMO-POS) in 2025, please refer to our full plan details page.
Blue Medicare Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3150.00 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 Enhanced (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays based on the drug tier and pharmacy type. For example, preferred generic drugs have a $6 copay at preferred pharmacies and no copay through mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Medicare Enhanced (HMO-POS) plan offers a range of benefits with varying costs. You'll find no copays for services like primary care visits, preventive services, routine hearing and vision exams, many dental services, home health, and transportation. The plan utilizes copays for other services, such as inpatient hospital stays, outpatient services, and specialist visits, and coinsurance for services like durable medical equipment and dialysis.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, with a copay of $335 for days 1-5 and $0 for days 6-90 for acute care, and a copay of $300 for days 1-5 and $0 for days 6-90 for psychiatric care. Additional days for inpatient hospital-acute are covered with no copay, but non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $335 copay, Observation Services with a $335 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, and Individual and Group Sessions for Outpatient Substance Abuse with a $20 copay. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Medicare Enhanced (HMO-POS) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Blue Medicare Enhanced (HMO-POS) plan covers ambulance services with a $250 copay for both ground and air ambulance services, and transportation services with no copay. Transportation services to plan-approved health-related locations are not covered, but transportation to any health-related location is covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the Blue Medicare Enhanced (HMO-POS) plan with a $135 copay, while Urgently Needed Services have a $55 copay. Worldwide Emergency Services, Worldwide Emergency Coverage, have a $135 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $250 copay; these services have a maximum plan benefit coverage of $100,000.
Primary Care See details
The Blue Medicare Enhanced (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $10 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $10 copay. Mental health and psychiatric services, and opioid treatment program services have a $20 minimum copay, with individual and group sessions covered. Additional Telehealth Benefits have a copay between $0 and $20. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services with no copay for services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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, and Counseling Services are not covered. Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Home and Bathroom Safety Devices and Modifications are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types of prescription hearing aids, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Blue Medicare Enhanced (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$20, and eyewear with a 20% coinsurance for contact lenses. Routine eye exams have no copay, and other eye exam services have a $20 copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental services are covered, with a $20 copay for Medicare dental services, and a $2,000 maximum plan benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay, but some have visit limits. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Medicare Enhanced (HMO-POS) plan, with prior authorization required. The plan has a $35 copay for Medicare Part B Insulin Drugs and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment have a 20% coinsurance, and Diabetic Supplies have between 0% and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Procedures/Tests have a copay between $0 and $25, while Diagnostic Radiological Services have a maximum copay of $300 and a minimum coinsurance of 20%, and Therapeutic Radiological Services have a maximum copay of $60 and a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Enhanced (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Blue Medicare Enhanced (HMO-POS) plan, but specific services such as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. The plan has a copay for Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Enhanced (HMO-POS) plan, with prior authorization required. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits, with Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services not covered. Over-the-Counter (OTC) Items have no copay, while Meal Benefits also have no copay.
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