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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 2025, 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. This plan received an overall rating of 4 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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:
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Drug Coverage
The Blue Cross Medicare Advantage Basic (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while preferred brand drugs have 50% coinsurance at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with copays, outpatient services with copays, and emergency services with a $125 copay. Primary care and preventive services have no copay, while specialist visits and some therapies have copays. Additional benefits include hearing exams, vision services, and dental services, with many services offered with no copay. The plan also covers home health, and diagnostic services with copays or coinsurance. However, certain services like some hearing aids, and some dental procedures, and other services may not be covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $260 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. Outpatient Hospital Services have a $250 copay, Observation Services have a $200 copay, and Ambulatory Surgical Center (ASC) Services have a $100 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Basic (HMO) plan, requiring prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan, with prior authorization required. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a $20 copay. Mental health specialty services and psychiatric services have a $30 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have no copay, and Opioid Treatment Program Services have a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services and an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) also have a copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered with no copay for one visit every year, and fitting/evaluation for hearing aids is covered with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a copay between $699 and $999 for two visits every year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with a $35 copay. Contact lenses and eyeglass lenses have no copay, and eyeglass frames have no copay, and eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers dental services, including oral exams and dental x-rays with no copay, and prophylaxis (cleaning) with no copay. The plan does not cover fluoride treatment, and some services such as endodontics and prosthodontics are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and between 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered under the Blue Cross Medicare Advantage Basic (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and does not have a copay. Prosthetics/Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have between 0% and 35% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 35% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $50, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $175, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Basic (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 covered with prior authorization and a doctor's referral, but the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Blue Cross Medicare Advantage Basic (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, with a $0 copay for OTC items; a doctor referral is required for Meal Benefits. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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.
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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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