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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Blue Medicare Choice (HMO) is a HMO plan offered by Blue Cross and Blue Shield of North Carolina available for the 2026 plan year 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 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4200.00 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:
Sign up for Blue Medicare Choice (HMO)
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Drug Coverage
The Blue Medicare Choice (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generics are also highly affordable, featuring no copay through preferred mail order and a low $4 copay for a one-month supply at a preferred retail pharmacy. For brand-name and specialty medications, the plan transitions from flat copays to coinsurance. Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs all require a 25% coinsurance across both preferred and standard pharmacy networks. Utilizing standard pharmacies or standard mail order will result in higher out-of-pocket copays for your generic medications.
Additional Benefits
The Blue Medicare Choice (HMO) plan offers robust coverage with many essential services featuring no copayments or coinsurance. Members enjoy no copay for primary care visits, preventive services, routine eye exams, home health care, and laboratory tests. For hospital care, there is no coinsurance, though inpatient stays require a $350 daily copay for the first six days and outpatient hospital services carry a copay up to $295. Specialist visits and physical therapies require low copays of $25 and $15 with no coinsurance, while routine hearing and dental exams have no copay. Emergency room visits carry a $150 copay that is waived if admitted, and urgent care services require a $65 copay. Additionally, major medical needs like dialysis and durable medical equipment are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue Medicare Choice (HMO) covers inpatient acute hospital stays with no coinsurance, a $350 daily copay for days 1 through 6, and no copay for days 7 and beyond, though upgrades and non-Medicare stays are not covered. Inpatient psychiatric care is also covered with no coinsurance and a $350 daily copay for days 1 through 5 (no copay for days 6 through 90), but additional psychiatric days and non-Medicare stays are excluded.
Outpatient Services See details
Outpatient services are covered by Blue Medicare Choice (HMO) with no coinsurance, featuring no copays for ambulatory surgical center services and outpatient blood services. Outpatient hospital services require a copay of $0 to $295, observation services carry a $295 copay per stay, and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Medicare Choice (HMO) plan with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Blue Medicare Choice (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Blue Medicare Choice (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum with no coinsurance and copays of $150, $65, and $275 respectively.
Primary Care See details
Blue Medicare Choice (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and psychiatric services require a $25 copay and no coinsurance. Physical, occupational, and speech therapies have a $15 copay and no coinsurance, telehealth services range from a $0 to $25 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Medicare Choice (HMO) covers preventive services, including annual physicals, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, with services such as health education, medical nutrition therapy, weight management programs, and alternative therapies excluded from coverage.
Hearing Services See details
Blue Medicare Choice (HMO) covers hearing exams with no coinsurance and a $25 copay for Medicare-covered exams, while routine exams and fitting evaluations have no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Blue Medicare Choice (HMO) with no deductibles, offering routine eye exams with no copay and contact lens exams for a $25 copay, both with no coinsurance up to a $200 annual limit. Eyewear is covered with no copay, featuring no coinsurance for glasses and upgrades, and a 20% coinsurance for contact lenses.
Dental Services See details
Blue Medicare Choice (HMO) covers Medicare-covered dental services for a $25 copay and no coinsurance, and offers partially covered dental benefits with no copay and no coinsurance. Covered services include oral exams, cleanings, x-rays, periodontics, and adjunctive general services, while fluoride, restorative, endodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Medicare Choice (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Blue Medicare Choice (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Choice (HMO) covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies feature a 0% to 20% coinsurance, though prior authorization is required for all categories and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Medicare Choice (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $15 copay for diagnostic tests. Radiological services require prior authorization and carry a minimum 20% coinsurance with copays starting at $0 for diagnostic and therapeutic services, while outpatient X-rays have no copay.
Home Health Services See details
Home health services are covered under Blue Medicare Choice (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Medicare Choice (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, although some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Medicare Choice (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Medicare Choice (HMO) partially covers Other Services, offering over-the-counter (OTC) items and chronic illness meals with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides a $25 allowance every three months, and the meal benefit requires a referral.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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