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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 $40.00. 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 $3700.00 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. During the initial coverage phase, you will pay a copay for your prescriptions. For example, preferred generic drugs have a $6 copay at a preferred pharmacy, while standard generic drugs have a $45 copay. For non-preferred drugs, you pay 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for 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. Inpatient hospital stays have copays, while outpatient services, like blood services, have no copay. The plan also includes coverage for services like ambulance, emergency, primary care, preventive, hearing, vision, and dental, each with specific copays, coinsurance, or no cost. This plan provides additional benefits such as home health services, home infusion bundled services, and skilled nursing facility (SNF) with copays or coinsurance. It also covers diagnostic and radiological services, medical equipment, and dialysis services, each with its own cost structure. The plan includes additional benefits like over-the-counter (OTC) items and meal benefits with no copay, but does not cover services such as cardiac rehabilitation or certain types of hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $335 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $300 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $335 copay, observation services with a $335 copay, ambulatory surgical center services with a $200 copay, individual and group outpatient substance abuse sessions with a copay between $20 and $20, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by 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 covers transportation services to any health-related location with no copay, up to 24 one-way trips per year. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Blue Medicare Enhanced (HMO-POS) plan. Emergency Services has a $135 copay, Urgently Needed Services has a $55 copay, and Worldwide Emergency Services has a $135 copay for Worldwide Emergency Coverage, a $55 copay for Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation, with a maximum plan benefit of $100,000.
Primary Care See details
Primary Care benefits include coverage for 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, Mental Health Specialty Services with a $20 copay for individual and group sessions, Other Health Care Professional with a copay between $0 and $20, Psychiatric Services with a $20 copay for individual and 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 an annual physical exam with no copay, and other services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit with no copay. This plan also covers additional preventive services, and services like Personal Emergency Response Systems, 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 with no copay. The plan does not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, enhanced disease management, telemonitoring services, remote access technologies, or counseling services.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams are covered with no copay, limited to one exam per year. Fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a copay between $699 and $999 for all types, but not covered for inner ear, outer ear, or over the ear hearing aids. 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. Routine eye exams have no copay, while other eye exam services have a $20 copay; 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 no copay for other services, and a $2,000 maximum 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, but maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Enhanced (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the Blue Medicare Enhanced (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and no copay. Prosthetic devices and medical supplies have a 20% coinsurance and no copay. Diabetic Supplies have between 0% and 20% coinsurance, and no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $25, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $300 and at least 20% coinsurance, Therapeutic Radiological Services have a copay up to $60 and at least 20% coinsurance, and 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 not covered by the Blue Medicare Enhanced (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Enhanced (HMO-POS) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, but for days 21-60, the copay is $214. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Blue Medicare Enhanced (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and also covers meal benefits with no copay and a doctor referral. Other services, including acupuncture, are not covered.
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