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Blue Cross Medicare Advantage Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Value (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 Value (HMO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Value (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Rockford, Peoria, Quincy, & St. Louis 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 Value (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 Value (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 Value (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 $2900.00 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 Value (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 type. 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 covered Part D drugs. Please note that if you qualify for the low-income subsidy (LIS), you may have a reduced premium.
Additional Benefits
The Blue Cross Medicare Advantage Value (HMO) plan offers a range of covered services with varying costs. You'll have a copay for inpatient hospital stays, outpatient services, and some therapies, as well as ambulance services. Primary care visits, preventive services, and some vision and dental services have no copay. This plan also covers hearing exams and hearing aids with copays, while also providing coverage for medical equipment and home health services. Additional benefits include a meal benefit, and over-the-counter items. However, some services like additional days in the hospital, some vision and dental services, and some therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you pay a $260 copay for days 1-7, and no copay for days 8-90. Additional days and upgrades for both services are not covered.
Outpatient Services See details
Outpatient Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan, including Outpatient Hospital Services with a $250 copay, Observation Services with a $225 copay, Ambulatory Surgical Center (ASC) Services with a $150 copay, and Outpatient Substance Abuse Services with a $75 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Value (HMO) plan, with a $55 copay. Prior authorization and a doctor's referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location are covered for 12 one-way trips per year, while 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 Value (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $135 copay, while Urgently Needed Services have a $30 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
Under the Blue Cross Medicare Advantage Value (HMO) plan, primary care physician services are covered with no copay, and chiropractic services require a $20 copay. Occupational therapy services have a $35 copay, while physical therapy and speech-language pathology services have a $35 copay.
Preventive Services See details
The Blue Cross Medicare Advantage Value (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services and kidney disease education services are covered, with no copay. Other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay. However, some services such as health education, in-home safety assessment, personal emergency response system, and others are not covered.
Hearing Services See details
Hearing Services are covered, including hearing exams and prescription hearing aids. Hearing exams have a $35 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) have a copay between $699 and $999, while the sub-services Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Eye exams and contact lenses have no copay, while eyewear has a $35 copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Value (HMO) plan covers Medicare Dental Services with a $35 copay, and other dental services including oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment, implants, and orthodontics are not covered. Restorative services and adjunctive general services have no coinsurance, while endodontics, prosthodontics, maxillofacial prosthetics, and prosthodontics (fixed) have a 20% coinsurance. 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 by the Blue Cross Medicare Advantage Value (HMO) plan, and require prior authorization. For Medicare Part B insulin drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a 20% coinsurance and requires authorization, while DME for use outside of the home is not covered. Prosthetic devices have a 20% coinsurance, medical supplies have a 20% coinsurance, and diabetic supplies have between 0-35% coinsurance while diabetic therapeutic shoes/inserts have a 35% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $175, while Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Value (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for covered services, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Value (HMO) 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 include a meal benefit with no copay, and over-the-counter items with a maximum benefit of $165 every three months. Acupuncture, Dual Eligible SNPs with Highly Integrated 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.
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