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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 NM 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 $20.00. 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 $4200.00 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 a $450 drug deductible before coverage begins. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail order services, while standard pharmacies charge copays starting at $5. Tier 2 generic drugs are also highly affordable, with copays as low as $1 at preferred pharmacies and standard pharmacy copays starting at $6. For higher-tier medications, costs are structured as coinsurance, with Tier 3 preferred brand drugs requiring an 18% coinsurance at preferred pharmacies and 20% at standard pharmacies. Tier 4 non-preferred drugs carry a 39% to 42% coinsurance, while Tier 5 specialty drugs require a flat 27% coinsurance across all pharmacy options for a one-month supply. Choosing preferred pharmacies or preferred mail order services consistently provides the lowest out-of-pocket costs under this plan.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers affordable access to essential medical services, featuring no copay or coinsurance for primary care visits and annual physical exams. Specialist visits require a $55 copay, while emergency care is covered with a $120 copay and urgent care has a $20 copay. For hospital stays, members pay a daily copay of $350 for the first five days of acute inpatient care and no copay for subsequent days. Diagnostic services like lab tests and X-rays are highly accessible with a low $5 copay, while durable medical equipment requires a 20% coinsurance with no copay. Routine vision care includes one annual eye exam with no copay, though dental and hearing benefits are limited to Medicare-covered services with copays of $35 and $50 respectively. Home health services and home infusions are also fully covered with no copay, helping to keep out-of-pocket costs manageable for home-based recovery.
Inpatient Hospital See details
Blue Cross Medicare Advantage Basic (HMO) covers inpatient hospital services with no coinsurance, requiring a $350 copay per day for days 1 to 5 of acute stays (no copay for days 6 and beyond) and a $315 copay per day for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization and referrals are required, and certain services like upgrades, 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, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a $0 to $350 copay, observation services require a $350 copay per stay, and outpatient substance abuse sessions have a $75 copay, with prior authorization and referrals required for most care.
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, with prior authorization required. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Basic (HMO) covers emergency services with a $120 copay (waived if admitted within three days) and urgently needed services with a $20 copay, both with no coinsurance and no deductible. Worldwide emergency and urgent care are also covered with a $120 copay and no coinsurance, although worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Basic (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits have a $55 copay and no coinsurance. Physical, occupational, and speech therapies require a $45 copay with no coinsurance, but chiropractic and podiatry services are not covered. Mental health and psychiatric services are covered with a $25 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Blue Cross Medicare Advantage Basic (HMO) with no copay and no coinsurance for annual physical exams, fitness benefits, remote access technologies, kidney disease education, and glaucoma screenings. Several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, nutritional/dietary benefits, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Basic (HMO) covers hearing exams with a $50 copay and no coinsurance, though routine hearing exams and fitting evaluations are not covered. Prescription hearing aids are technically covered, but no specific types—including inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids—are covered in practice.
Vision Services See details
Blue Cross Medicare Advantage Basic (HMO) covers one routine eye exam per year with no copay, no coinsurance, and no deductible, though other eye exams are not covered. Eyewear services, including contact lenses and eyeglasses, are not covered under this plan.
Dental Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers dental services, offering coverage only for Medicare-covered dental services with a $35.00 copay and no coinsurance. Routine and comprehensive dental services, including cleanings, oral exams, x-rays, fluoride treatments, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Basic (HMO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance up to 20% coinsurance, while Part B insulin has a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Basic (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
Medical Equipment is covered under the Blue Cross Medicare Advantage Basic (HMO) plan with no copays, though prior authorization is required for all services. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance, while diabetic supplies from specified manufacturers carry a coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Basic (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and outpatient X-rays require a $5 copay, diagnostic procedures range from no copay up to $50, and diagnostic radiological services have no copay while therapeutic radiological services start at a $30 copay.
Home Health Services See details
Blue Cross Medicare Advantage Basic (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Basic (HMO) covers some cardiac rehabilitation services with no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization and referrals are required, and copayments for these services range from $15.00 to $30.00.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and days 50 through 100, and a $218 daily copay for days 21 through 49. Prior authorization and referrals are required for these services, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Blue Cross Medicare Advantage Basic (HMO) indicates that some services are covered under the Other Services benefit, but acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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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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