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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 $34.00. 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 varying copays depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $6 copay at preferred pharmacies and no copay at preferred mail order pharmacies. For non-preferred drugs, you will pay 33% coinsurance. In the catastrophic coverage phase, you pay nothing for covered drugs after your yearly out-of-pocket drug costs reach $2000.00.
Additional Benefits
The Blue Medicare Enhanced (HMO-POS) plan provides a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, including primary care, have a copay. This plan also offers coverage for ambulance, emergency, and hearing services with copays. Vision and dental services are covered, and many preventive services are available with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $335 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $300 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and no additional days or non-Medicare-covered stay are covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a $335 copay, Ambulatory Surgical Center (ASC) Services have a $200 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $20 copay. There is no copay for Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Medicare Enhanced (HMO-POS) plan, but requires prior authorization. You will have a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Medicare Enhanced (HMO-POS) plan. Ground and air ambulance services each have a $250 copay, and there is no coinsurance. Transportation services to any health-related location are covered with no copay.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Blue Medicare Enhanced (HMO-POS) plan. Emergency Services have a $135 copay, Urgently Needed Services have a $55 copay, Worldwide Emergency Coverage has a $135 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
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 mental health specialty services with a $20 copay for individual or group sessions. The plan also covers other health care professionals, with a copay ranging from $0 to $20, psychiatric services with a $20 copay for individual or group sessions, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits with a copay between $0 and $20, and opioid treatment program services with a $10 copay. However, 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 such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. This plan does not cover health education, in-home safety assessments, medical nutrition therapy, 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 benefits, home-based palliative care, and enhanced disease management, telemonitoring services, remote access technologies, or counseling services.
Hearing Services See details
Hearing exams are covered with a $20 copay, while routine hearing exams have no copay for one visit per year, and fitting/evaluation for hearing aids have 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 hearing aids are not covered. OTC hearing aids are 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 and no copay for eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay, and Other Eye Exam Services have a $20 copay.
Dental Services See details
Dental services are covered, with a $20 copay for Medicare dental services, and other services including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery, which have no copay. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. There is a $2,000 maximum plan benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Medicare Enhanced (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Medicare Enhanced (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay, and Diagnostic Radiological Services and Therapeutic Radiological Services have up to a $300 and $60 copay, respectively, with at most 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Enhanced (HMO-POS) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Blue Medicare Enhanced (HMO-POS) plan. However, 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Enhanced (HMO-POS) plan. For days 1-20 and 61-100, there is no copay, while days 21-60 have a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay, and Meal Benefits also have no copay. However, Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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