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BlueJourney Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueJourney Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueJourney Value (HMO) in 2025, please refer to our full plan details page.
BlueJourney Value (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 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 BlueJourney 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 BlueJourney Value (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $53.00. 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 $6000.00 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 Value (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and the pharmacy you use. For example, you will have no copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D is $34.70. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for covered Part D drugs.
Additional Benefits
The BlueJourney Value (HMO) plan offers a range of benefits, including inpatient hospital stays with a $125 copay for the first five days, and no copay for days 6-90. Outpatient services, emergency services, primary care, and vision services have varying copays, with many preventive services and home health services covered at no cost. Dental services include Medicare dental services with a $25 copay and other services with no copay, but some services are covered with coinsurance. This plan also covers ambulance and transportation services, hearing services, and home infusion services, with specific copays or coinsurance amounts. Additionally, it provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility services with copays. The plan offers an over-the-counter item benefit, but does not cover certain services like cardiac rehabilitation, private duty nursing, and others.
Inpatient Hospital See details
Inpatient Hospital-Acute services have a copay of $125 for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric services have a copay of $125 for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered by the BlueJourney Value (HMO) plan. Outpatient Hospital Services have a copay between $0 and $250, and Observation Services have a $225 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including both individual and group sessions, have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueJourney Value (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueJourney Value (HMO) plan. Ground and air ambulance services have a $200 copay, and there is no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the BlueJourney Value (HMO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Coverage has a $125 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have a $5 copay, Chiropractic Services have a $20 copay, Occupational Therapy Services have a $30 copay, and Physician Specialist Services have a $25 copay. Mental Health Specialty Services and Psychiatric Services both have a $25 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have a copay between $0 and $30. Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
The BlueJourney Value (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including medical nutrition therapy, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay. Some preventive services such as in-home safety assessments, personal emergency response systems, 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 benefits, 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, counseling services, are not covered.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $25 copay, Fitting/Evaluation for Hearing Aid with no copay, Prescription Hearing Aids (all types) with a copay between $499 and $999, and OTC Hearing Aids with a $499 copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$25, and eyewear with a copay of $0. Eyeglasses (lenses and frames), and contact lenses are included in the eyewear benefit, with a combined maximum of $200 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueJourney Value (HMO) plan covers dental services, including Medicare Dental Services with a $25 copay, and other dental services with no copay. This plan also covers Other Diagnostic Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, fixed, and Oral and Maxillofacial Surgery with a 50% coinsurance. Orthodontic Services are covered under Diagnostic and Preventive Dental, while Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the BlueJourney Value (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. For DME, there is a 20% coinsurance. For Medical Supplies, there is a 20% coinsurance. For Diabetic Supplies, there is no copay, and for Diabetic Therapeutic Shoes/Inserts, there is a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Outpatient X-Ray Services have a $25 copay, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the BlueJourney Value (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 not covered by the BlueJourney Value (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueJourney Value (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $75 every three months, but does not cover acupuncture, meal benefits, 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.
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