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Blue Medicare Choice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Choice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Choice (HMO) in 2025, please refer to our full plan details page.
Blue Medicare Choice (HMO) is a HMO 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 Choice (HMO) 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 Choice (HMO).
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 Choice (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $2.50. You must continue to pay paying your reduced 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 $375.00 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 $2800.00 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 Choice (HMO) plan has a $375 deductible for prescription drugs. After you meet the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and where you get your prescriptions filled. For example, for preferred generic drugs, you will pay a $6 copay at a preferred pharmacy, and no copay if you use preferred mail order. The plan covers drugs in the initial coverage phase up to $2000 in total drug costs. Once you reach that amount, you enter the next coverage phase.
Additional Benefits
The Blue Medicare Choice (HMO) plan offers a wide range of benefits with varying cost-sharing. The plan includes inpatient and outpatient hospital services, with copays ranging from $0 to $295. Primary care, preventive services, and many vision and dental services have no copay, while hearing services have a copay. Additional benefits include ambulance services, emergency services, and coverage for services like home health, and skilled nursing facilities, with specific copays and coinsurance amounts. The plan also covers home infusion, dialysis, and medical equipment, with coinsurance applying to some of these services. Other services include meal benefits and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, the copay is $295 for days 1-5, and no copay for days 6-90, while days 91-999 have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, the copay is $295 for days 1-5, and no copay for days 6-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital and Observation Services have a $295 copay, Ambulatory Surgical Center (ASC) Services have a $275 copay, and Outpatient Substance Abuse Services have a $15 copay for both individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Medicare Choice (HMO) 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 Choice (HMO) plan. Ground and air ambulance services have a $275 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Blue Medicare Choice (HMO) plan, with a $135 copay. Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage has a $135 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay. Occupational Therapy Services have a $10 copay. Physician Specialist Services have a $15 copay. Mental Health Specialty Services have a copay of $15 for both individual and group sessions. Other Health Care Professional services have a copay between $0 and $15. Psychiatric Services have a copay of $15 for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $10 copay. Additional Telehealth Benefits have a copay between $0 and $15. Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
The Blue Medicare Choice (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services are also covered with no copay for services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $15 copay, and routine hearing exams 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 prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Blue Medicare Choice (HMO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with a 20% coinsurance for contact lenses and no copay for eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), and adjunctive general services with no copay; however, fluoride treatment, restorative services, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Medicare Dental Services require a $15 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Medicare Choice (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Blue Medicare Choice (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance. Diabetic Equipment is covered, with Diabetic Supplies having a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts having a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Medicare Choice (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $15, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $60. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Choice (HMO) 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 Choice (HMO) 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 Choice (HMO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a copay of $214. Additional days beyond Medicare coverage and non-Medicare covered stays are not covered.
Other Services See details
The Blue Medicare Choice (HMO) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items with no copay, a maximum benefit of $76 every three months, and includes nicotine replacement therapy and Naloxone coverage. Acupuncture, Dual Eligible SNPs, 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 are not covered. The plan also covers Meal Benefits with no copay when referred by a doctor.
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