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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 Central & Southern IL Markets. 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 $5500.00 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 you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. This plan offers an enhanced alternative drug benefit.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers a wide range of benefits with varying costs. You'll find no copay for primary care, preventive services like an annual physical, and home health services. Inpatient hospital stays have a copay, starting at $325 for acute care, while outpatient services such as hospital and observation have a $250 copay. The plan also covers services like hearing and vision exams with no copay, and offers coverage for hearing aids and eyewear at a copay. Dental services include oral exams, x-rays, and cleaning with no copay, but other dental work may have coinsurance. Other benefits include ambulance services, emergency services, and skilled nursing facility care, each with their own associated costs.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, you'll pay a $250 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and 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 and Observation Services each have a $250 copay, Ambulatory Surgical Center (ASC) Services have a $175 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Basic (HMO) plan, requiring 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 by the Blue Cross Medicare Advantage Basic (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance, but 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 under the Blue Cross Medicare Advantage Basic (HMO) plan, with copays of $125, $50, and $125 respectively, 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, occupational therapy, physician specialist, mental health specialty, psychiatric services, physical therapy, speech-language pathology services, and opioid treatment program services are covered, but may require prior authorization or a doctor referral, and have a copay. Other health care professional services have a copay between $0 and $25. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, an annual physical exam, and additional preventive services. The annual physical exam has no copay, while the additional services include Fitness Benefit and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), both of which have no copay.
Hearing Services See details
Hearing services with the Blue Cross Medicare Advantage Basic (HMO) plan include hearing exams with a $25 copay, routine hearing exams (1 per year) 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, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, with no copay, and eyewear, which has a $25 copay for contact lenses, eyeglasses (lenses and frames), eyeglass frames, and upgrades. Routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames are covered. 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 with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay, all limited to a certain number of visits per year. Fluoride treatment, implant services, and orthodontics are not covered. Other services, such as restorative services and adjunctive general services have no coinsurance, while endodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, and oral and maxillofacial surgery have a 20% coinsurance, and periodontics and oral and maxillofacial surgery have a coinsurance between 0% and 20%.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Blue Cross Medicare Advantage Basic (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Medical Supplies and Prosthetic Devices have a 20% coinsurance, and Diabetic Supplies have between 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay that is at most $250, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
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 by the Blue Cross Medicare Advantage Basic (HMO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. For days 1-20 and 50-100, there is no copay, and for days 21-49, the copay is $214.
Other Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $105.00 every three months, and also covers meal benefits with a $0 copay when a doctor referral is required. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services 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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