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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 Oklahoma. 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 $3900.00 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. 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. If you qualify for the low-income subsidy, your Part D costs are $0.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan provides coverage for a wide range of healthcare services. This plan includes no copay for primary care, preventive services, and home health services. There is also a $0 copay for routine hearing exams and eye exams. The plan has copays for inpatient hospital stays, outpatient services, and specialist visits. It also covers hearing aids with a copay, and vision and dental services with no or low copays. The plan also offers additional benefits like OTC items and access to ambulance services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $275 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $324 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $250 copay, ambulatory surgical center services have a $200 copay, and outpatient blood services have no copay. Outpatient substance abuse services have a $75 copay per individual or group session.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Basic (HMO) plan with a $55 copay. Prior authorization and a doctor referral are required for this benefit.
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; however, 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 by the Blue Cross Medicare Advantage Basic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, and Urgently Needed Services have a $35 copay; all have 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 services with a $20 copay, and specialist services with a $22 copay. Occupational therapy services have a $35 copay, and physical therapy and speech-language pathology services have a $40 copay. Mental health and psychiatric services, as well as opioid treatment program services, have a minimum copay of $30, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, with annual physical exams covered with no copay. Additional preventive services include coverage for Fitness Benefit and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) with no copay. Some services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, 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, and Telemonitoring Services.
Hearing Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers hearing exams with a $35 copay. Routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids has no copay. Prescription Hearing Aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $699 and $999. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear has no copay, and includes contact lenses (unlimited), eyeglass lenses (1 pair per year), and eyeglass frames (1 frame per year), while eyeglasses and upgrades are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, and no copay for oral exams, dental x-rays, and prophylaxis (cleaning). Fluoride treatment and orthodontics are not covered, while endodontics, prosthodontics (removable, and fixed), maxillofacial prosthetics, and implant services have 20% coinsurance. Periodontics and oral and maxillofacial surgery have a 0%-20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, 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 under the Blue Cross Medicare Advantage Basic (HMO) plan, but require prior authorization and a doctor's referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay ranging from $0 to $50, Lab Services have a $5 copay, and Diagnostic Radiological Services have a copay of at most $250. Therapeutic Radiological Services have a coinsurance of at least 20%, and 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 any of the sub-services. A doctor referral and prior authorization are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan, but require prior authorization and a doctor referral. You will have no copay for days 1-20 and days 50-100, while days 21-49 have a $214 copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $105 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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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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