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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 Springfield & Downstate 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 $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 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 $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:
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 annual prescription drug deductible. For generic medications, this plan offers excellent savings, including no copay for Tier 1 preferred generics filled at preferred pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, with copays starting at just $1 for a one-month supply at preferred locations. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brands require a 17% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 38% coinsurance. Specialty drugs in Tier 5 carry a 27% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and routine preventive care. For specialist visits, members pay a $39 copay, while emergency room visits require a $125 copay, which is waived if admitted. Inpatient hospital stays require a daily copay of $325 for the first eight days of acute care, with no coinsurance. This plan also includes valuable supplemental benefits, providing routine dental cleanings, annual eye exams, and routine hearing exams with no copay. Prescription hearing aids are available with copays ranging from $699 to $999, and members receive a $95 quarterly allowance for over-the-counter items with no copay. Additionally, home health services are covered with no copay or coinsurance, while durable medical equipment requires a 20% coinsurance and no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Basic (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 8 of acute stays and a $250 daily copay for days 1 through 7 of psychiatric stays, followed by no copay for subsequent days. Prior authorization and referrals are required, and 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, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $250, observation services have a $250 copay per stay, and outpatient substance abuse sessions carry a $75 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Blue Cross Medicare Advantage Basic (HMO) 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 both. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Basic (HMO) covers emergency services with a $125 copay and no coinsurance (waived if admitted to the hospital within three days), and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Basic (HMO) offers primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits require a $39 copay and no coinsurance, while physical, occupational, speech, mental health, psychiatric, and opioid treatment therapies require a $40 copay and no coinsurance; chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Blue Cross Medicare Advantage Basic (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, fitness benefits, and screenings. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Basic (HMO), featuring Medicare-covered exams for a $25 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $699 to $999 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Basic (HMO), featuring one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered up to a $100 annual limit with no coinsurance and a $25 copay (with no copay for contact lenses, eyeglass lenses, and frames), while upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by Blue Cross Medicare Advantage Basic (HMO), featuring no copay or coinsurance for preventive care like exams and cleanings, and a $25 copay with no coinsurance for Medicare-covered dental. Comprehensive services such as endodontics and restorative care have no copay and up to 20% coinsurance under a $750 annual maximum, though fluoride, implants, orthodontics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Basic (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy apply. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Basic (HMO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization and a referral are required.
Medical Equipment See details
Blue Cross Medicare Advantage Basic (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic services, with no copays. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Basic (HMO) covers diagnostic services with no coinsurance and a copay of $0 to $50 for tests, while lab services and outpatient X-rays have no copay. Diagnostic radiological services have a copay starting at $0, and therapeutic radiological services require a minimum 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Home health services are covered under the Blue Cross Medicare Advantage Basic (HMO) plan 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 a referral are required for any covered services.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 to 20 and days 50 to 100, but a $218 daily copay applies for days 21 to 49, with no coverage provided for days beyond the 100-day Medicare limit.
Other Services See details
Blue Cross Medicare Advantage Basic (HMO) provides partial coverage for other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $95 every three months. Acupuncture and meal benefits are not covered, though unused OTC benefits will carry forward to the next period.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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