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Blue Cross Medicare Advantage Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Basic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Basic (HMO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Basic (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Chicago Metro Area HMO. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Basic (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 Cross Medicare Advantage Basic (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 Cross Medicare Advantage Basic (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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $450.00 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 $4500.00 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:
Sign up for Blue Cross Medicare Advantage Basic (HMO)
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Drug Coverage
The Blue Cross Medicare Advantage Basic (HMO) plan features an annual drug deductible of $450. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing as little as a $1 copay at preferred pharmacies and preferred mail-order services, compared to $6 at standard pharmacies. Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 19% coinsurance at preferred pharmacies and 22% at standard pharmacies, while Tier 4 non-preferred drugs carry a 40% or 44% coinsurance depending on your pharmacy choice. Specialty drugs in Tier 5 require a 27% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers affordable essential coverage with no copay for primary care visits, telehealth, and routine preventive services. For specialized medical care, members pay a $10 copay for specialists and no copay for routine diagnostic lab services. Emergency room visits require a $125 copay, while inpatient acute hospital stays feature a $170 daily copay for the first seven days and no copay for day eight and beyond. Additional benefits include partially covered dental, vision, and hearing services, featuring no copay for routine dental cleanings, annual eye exams, and routine hearing exams. Members also receive a quarterly seventy-dollar over-the-counter allowance with no copay, as well as home health services with no copay. For other healthcare needs, durable medical equipment is subject to a 20% coinsurance, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Blue Cross Medicare Advantage Basic (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $170 daily copay for days 1 through 7 and no copay for day 8 and beyond. Inpatient psychiatric stays are also covered with no coinsurance, featuring a $260 daily copay for days 1 through 7 and no copay for days 8 through 90, though non-Medicare-covered stays and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Basic (HMO) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $200 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay and no coinsurance.
Partial Hospitalization See details
Blue Cross Medicare Advantage Basic (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Basic (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Basic (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency services are partially covered with a $125 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits under the Blue Cross Medicare Advantage Basic (HMO) plan are partially covered, as podiatry and chiropractic services are not covered. Covered services feature no coinsurance, offering no copay for primary care and telehealth, a $10 copay for specialists, a $30 copay for mental health and psychiatric sessions, and a $35 copay for physical, occupational, and speech therapies.
Preventive Services See details
Blue Cross Medicare Advantage Basic (HMO) covers preventive services, including annual physicals, kidney disease education, and fitness benefits, with no copay and no coinsurance. These additional benefits are only partially covered, as services like health education, in-home safety assessments, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Hearing Services are partially covered by Blue Cross Medicare Advantage Basic (HMO) with no coinsurance, offering Medicare-covered exams for a $35 copay, routine exams and fittings with no copay, and up to two prescription hearing aids per year for a $699 to $999 copay. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by Blue Cross Medicare Advantage Basic (HMO), offering one routine eye exam per year with no copay and no coinsurance, while other eye exams are not covered. Covered eyewear has a $35 copay and no coinsurance up to a $100 annual limit—featuring no copay for contact lenses, eyeglass lenses, and frames—while upgrades and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and preventive exams, cleanings, and x-rays with no copay and no coinsurance. Comprehensive dental care is covered up to a $1,000 annual maximum with no copays and 0% to 50% coinsurance, though fluoride, implants, orthodontics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Basic (HMO) with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Basic (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Medical Equipment is covered by Blue Cross Medicare Advantage Basic (HMO) with no copays, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, while diabetic supplies and therapeutic shoes range from no coinsurance up to 35% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Basic (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $50 copay for diagnostic tests. Covered radiological services require no copay for outpatient X-rays and diagnostic radiology, while therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Blue Cross Medicare Advantage Basic (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Medicare Advantage Basic (HMO) with no coinsurance and copayments ranging from $20 to $30, although prior authorization and referrals are required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 to 20 and days 40 to 100, a $218 daily copay for days 21 to 39, and additional days beyond the standard 100 days are not covered.
Other Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $70 maximum benefit every three months. Acupuncture and meal benefits are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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