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BlueJourney Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueJourney Premier (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueJourney Premier (HMO) in 2025, please refer to our full plan details page.
BlueJourney Premier (HMO) is a HMO plan offered by CAPITAL BLUE CROSS available for enrollment in 2025 to people living in 21 Counties in Central PA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BlueJourney Premier (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 BlueJourney Premier (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 BlueJourney Premier (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $84.00. 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 $4700.00 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 BlueJourney Premier (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays based on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies and $15 copay at standard pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. However, you may still pay for any enhanced benefits.
Additional Benefits
The BlueJourney Premier (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services, such as primary care, specialist visits, and mental health services, with copays ranging from $5 to $20. The plan also covers ambulance and transportation services, emergency services, and various preventive services with no copay, as well as vision and dental services with varying copays and coinsurance. Additional benefits include hearing exams, prescription hearing aids, and coverage for medical equipment and home health services. The plan provides a quarterly allowance for over-the-counter items and covers skilled nursing facility stays with a copay. However, some services, such as routine chiropractic care, podiatry services, and certain types of hearing aids, are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $125 copay for days 1-4 and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $200, Observation Services have a $200 copay, Ambulatory Surgical Center Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.00. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueJourney Premier (HMO) plan, and requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueJourney Premier (HMO) plan. Ground and air ambulance services have a $150 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for 12 one-way trips per year, and transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $125, $30, and $125, respectively, with no coinsurance, while Worldwide Urgent Coverage has a $30 copay with no coinsurance, and Worldwide Emergency Transportation is not covered. Worldwide Emergency Services has a maximum plan benefit coverage of $20,000.
Primary Care See details
The BlueJourney Premier (HMO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $20 copay, while occupational therapy services have a $20 copay, and no coinsurance. Specialist visits, mental health specialty services, individual and group psychiatric sessions, physical therapy, and speech-language pathology services have a $20 copay. Additional telehealth benefits have a copay between $0 and $20, and opioid treatment program services have a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The BlueJourney Premier (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, as well as kidney disease education services, are covered with a $0 copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Some services, like In-Home Safety Assessment, Personal Emergency Response System, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The BlueJourney Premier (HMO) plan covers hearing exams with a $20 copay, as well as routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $499 and $999, and OTC hearing aids have a $499 copay. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The BlueJourney Premier (HMO) plan covers vision services, including routine eye exams with a copay of $0-$20, and eyewear with no copay. Eyeglasses (lenses and frames) and contact lenses are covered, with a combined maximum benefit of $200 per year for eyewear. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueJourney Premier (HMO) plan covers dental services, with a $20 copay for Medicare Dental Services and no copay for Other Dental Services. Other Diagnostic Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with 50% coinsurance, while Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment are covered with no coinsurance. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueJourney Premier (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueJourney Premier (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered with no copay for diagnostic procedures and tests, and no copay for lab services. Diagnostic Radiological Services have a copay of up to $50, and Therapeutic Radiological Services have a coinsurance of at least 20%, while Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the BlueJourney Premier (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 under the BlueJourney Premier (HMO) plan, but none of the listed services are covered. There is a copay for some cardiac and pulmonary rehabilitation services, but no additional cost information is provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueJourney Premier (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $200. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays are not covered.
Other Services See details
The BlueJourney Premier (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $100 every three months. Acupuncture, Meal Benefit, 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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