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Blue Cross Medicare Advantage Premier Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Premier 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 Premier Plus (HMO-POS) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Premier 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 HMO POS. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Premier 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 Premier 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 Premier Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $83.00. 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 $3500.00 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 Premier Plus (HMO-POS)
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Drug Coverage
The Blue Cross Medicare Advantage Premier Plus (HMO-POS) plan features an annual drug deductible of $450. For Tier 1 preferred generic drugs, members enjoy no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, with copays starting at just $1 at preferred locations and up to $18 for standard pharmacy fills. For brand-name and specialty medications, cost sharing shifts to a percentage-based coinsurance. Tier 3 preferred brands require a 17% coinsurance at preferred pharmacies and 19% at standard pharmacies, while Tier 4 non-preferred drugs carry a 40% to 43% coinsurance. Tier 5 specialty drugs require a flat 27% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The Blue Cross Medicare Advantage Premier Plus (HMO-POS) plan features no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. Specialist visits require a $40 copay, while inpatient hospital stays carry a $225 daily copay for the first seven or eight days before transitioning to no copay for additional days. Emergency room visits have a $135 copay, which is waived if you are admitted, and urgent care is available for a $30 copay. Routine dental, vision, and hearing exams are also covered with no copay, alongside a $100 annual eyewear allowance and up to $750 in comprehensive dental benefits. Home health services and skilled nursing facility stays for the first 20 days require no copay or coinsurance. For medical equipment and dialysis services, members will pay no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Covered acute stays require a $225 daily copay for days 1 through 8 and no copay for additional unlimited days, while psychiatric stays require a $225 daily copay for days 1 through 7 and no copay for days 8 through 90.
Outpatient Services See details
Outpatient services are covered by Blue Cross Medicare Advantage Premier Plus (HMO-POS) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $250, observation services carry a $225 copay per stay, and outpatient substance abuse sessions have a $75 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Blue Cross Medicare Advantage Premier Plus (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Blue Cross Medicare Advantage Premier Plus (HMO-POS) with a $135 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed care is available for a $30 copay and no coinsurance, while worldwide emergency and urgent services are partially covered with a $135 copay and no coinsurance, excluding worldwide emergency transportation.
Primary Care See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $40 copay with no coinsurance. Covered therapies, including physical, occupational, and mental health services, carry copays ranging from $30 to $40 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. While fitness benefits and remote access technologies are covered at no cost, other supplemental services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers Medicare-covered hearing exams with a $5 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $699 to $999 copay for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Premier Plus (HMO-POS) with no copay and no coinsurance, offering one routine eye exam per year and a $100 annual maximum for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) dental services are partially covered, featuring Medicare-covered dental care for a $45 copay and no coinsurance, alongside preventive exams and cleanings with no copay and no coinsurance. Comprehensive dental benefits offer a $750 annual maximum with no copay and 0% to 20% coinsurance, though fluoride, implants, orthodontics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers Home Infusion bundled Services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance. Covered Part B insulin has a $35 copay and 0% to 20% coinsurance, with prior authorization and step therapy requirements applying to these services.
Dialysis Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with no copay and a 20% coinsurance for most items. Diabetic supplies feature a coinsurance ranging from no coinsurance up to 20%, and prior authorization is required for these covered benefits.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers diagnostic and radiological services, requiring prior authorization and referrals. Outpatient lab services and X-rays have no copay, diagnostic tests have no coinsurance and a copay up to $50, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Premier Plus (HMO-POS) plan with no copay and no coinsurance. Members are required to obtain prior authorization and a referral to receive these services.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though referrals and prior authorization are required. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Premier Plus (HMO-POS) with no coinsurance, featuring no copay for days 1 to 20 and days 40 to 100, and a $218 daily copay for days 21 to 39. Prior authorization and referrals are required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Premier Plus (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $65 allowance every three months. Acupuncture, meal benefits, and naloxone coverage are not covered under this benefit.
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