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Blue Medicare Essential (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Essential (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Essential (HMO) in 2026, please refer to our full plan details page.
Blue Medicare Essential (HMO) is a HMO plan offered by CuraCor Solutions Corp. available for enrollment in 2025 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 Essential (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 Essential (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 Essential (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 $62.50. 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 $615.00 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 $9250.00 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 Essential (HMO) plan features an annual drug deductible of $615. You can maximize your savings by using preferred pharmacies or preferred mail-order services, which offer no copay for Tier 1 preferred generic and Tier 6 select care drugs. Tier 2 generic prescriptions also feature no copay through preferred mail order and a low $4 copay for a one-month supply at preferred pharmacies. For higher-tier medications, including Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance across all pharmacy options. Standard pharmacies and standard mail-order services are also available for generic medications but require higher copays, such as $15 for Tier 1. This plan offers strong cost-saving opportunities on generic drugs while maintaining steady coinsurance for brand-name and specialty medications.
Additional Benefits
The Blue Medicare Essential (HMO) plan offers comprehensive coverage with no deductibles for vision services and no coinsurance for many key benefits. Inpatient hospital stays require a $407 copay for the first six days and no copay thereafter, while primary care visits have a $10 copay and specialist visits cost $45. Emergency room care is available with a $115 copay, which is waived if you are admitted, and urgently needed services require a $40 copay. Routine vision exams, glasses, and select preventive dental services are covered with no copay and no coinsurance, helping you save on everyday health needs. Additionally, the plan features no copay for home health services and routine hearing exams, though medical equipment and dialysis services require a 20% coinsurance. Skilled nursing facility care is also accessible, offering no copay for the first 20 days of your stay.
Inpatient Hospital See details
Blue Medicare Essential (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $407 copayment for days 1 through 6 and no copay for days 7 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, featuring a $407 copayment for days 1 through 5 and no copay for days 6 through 90, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Medicare Essential (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a $0 to $335 copay, observation services require a $335 copay per stay, and outpatient substance abuse sessions have a $40 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Blue Medicare Essential (HMO) plan with a $40 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Blue Medicare Essential (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, subject to prior authorization. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Blue Medicare Essential (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with no coinsurance and copays ranging from $40 to $275.
Primary Care See details
Blue Medicare Essential (HMO) covers primary care visits for a $10 copay, specialist visits for a $45 copay, and physical therapy for a $25 copay, all with no coinsurance. Mental health sessions require a $40 copay with no coinsurance, and while some chiropractic services are covered for a $15 copay with no coinsurance, routine chiropractic, other chiropractic, and podiatry services are not covered.
Preventive Services See details
Blue Medicare Essential (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance for services like fitness benefits and caregiver support, though sub-services such as health education and weight management programs are not covered.
Hearing Services See details
Blue Medicare Essential (HMO) covers hearing exams with a $25 copay for Medicare-covered visits, no copay for routine exams and fitting evaluations, and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $499 to $999 and no coinsurance for up to two aids per year, while OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Blue Medicare Essential (HMO) covers vision services with no deductibles, featuring routine eye exams, eyeglasses, and frames with no copay and no coinsurance. Contact lens exams require a $25 copay with no coinsurance, while contact lenses are covered with no copay and a 20% coinsurance.
Dental Services See details
Blue Medicare Essential (HMO) dental services are partially covered, offering Medicare-covered dental care for a $45 copay and no coinsurance, and select preventive and comprehensive services—including exams, cleanings, x-rays, periodontics, and adjunctive general services—for no copay and no coinsurance. Fluoride, restorative services, endodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Medicare Essential (HMO) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Blue Medicare Essential (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Essential (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment and supplies are also covered with no copay and coinsurance ranging from no coinsurance to 20%, subject to prior authorization.
Diagnostic and Radiological Services See details
Blue Medicare Essential (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $25, while diagnostic and therapeutic radiological services require a minimum 20% coinsurance and a copay starting at $0.
Home Health Services See details
Blue Medicare Essential (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Blue Medicare Essential (HMO) plan, as all sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Medicare Essential (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Medicare Essential (HMO) partially covers other services with no copay and no coinsurance, providing meal benefits for chronic illnesses with a referral and select over-the-counter items limited to nicotine replacement therapy via catalogue through the Quitline Program. Acupuncture and other additional services are not covered under this plan.
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