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Blue Cross Medicare Advantage Basic Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Basic Plus (HMO-POS). 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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Basic Plus (HMO-POS) is a HMO-POS 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 Plus (HMO-POS) 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 Plus (HMO-POS).
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 Plus (HMO-POS), 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 $6750.00 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 Plus (HMO-POS)
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Drug Coverage
The Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, after the deductible, you will pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the next coverage phase. In the catastrophic coverage phase, you pay nothing for Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services like primary care and preventive services have no copay. You'll also find coverage for hearing, vision, and dental services, with copays for exams, eyewear, and dental procedures. The plan also includes coverage for ambulance and transportation services, emergency services, and home health services with no copay. Additionally, you may have costs associated with services like partial hospitalization, prescription hearing aids, and durable medical equipment, which come with their own copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a $300 copay for days 1-8 and no copay for days 9-90, and Inpatient Hospital Psychiatric with a $215 copay for days 1-7 and no copay for days 8-90. Additional days and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $275 copay, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, Outpatient Substance Abuse Services with a $75 copay for both Individual and Group Sessions, and Outpatient Blood Services with no copay. Prior authorization and doctor referrals may be required.
Partial Hospitalization See details
Partial hospitalization is covered by the Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan, and requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including air ambulance services with a 20% coinsurance, ground ambulance services with a $250 copay, and transportation services with no copay for plan-approved health-related locations, offering up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage each have a $125 copay, while Urgently Needed Services has a $40 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $35 copay, while physician specialist services have a $25 copay, and physical therapy and speech-language pathology services have a $40 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, while additional telehealth benefits have no copay, and opioid treatment program services have a $35 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other preventive services are covered. Other covered services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing services include hearing exams with a $5 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, including routine eye exams. Eyewear has a $35 copay, and covers contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum of $100 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Orthodontic services are covered up to a maximum of $1000 per year. Restorative services are covered with no coinsurance, and adjunctive general services are covered with 50% coinsurance. Periodontics and oral and maxillofacial surgery are covered with 20% coinsurance. Fluoride treatment, implant services, and orthodontics are not covered. Endodontics, prosthodontics (removable and fixed), and maxillofacial prosthetics are offered as optional supplemental benefits; contact the plan for details.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a coinsurance between 0% and 20%. The plan does not cover Durable Medical Equipment for use outside the home.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay of up to $50, and lab services with no copay. Outpatient X-ray services have no copay. Diagnostic radiological services have a copay of up to $225 and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Basic Plus (HMO-POS) 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 not covered by the Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Basic Plus (HMO-POS) plan. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. OTC items have no copay, and Meal Benefits also have no copay, but require a doctor's referral. 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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