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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Blue Cross Medicare Advantage Basic (HMO) is a HMO plan offered by Ghs Health Maintenance Organization, Inc. available for the 2026 plan year to people living in Oklahoma HMO. This plan received an overall rating of 3.5 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
Health deductible: information not available.
This plan has a $450.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4200.00 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 features an annual drug deductible of $450. For Tier 1 preferred generic drugs, members enjoy no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, with copays starting at just $1 for a one-month supply at preferred locations. Higher-tier prescription drugs require coinsurance, starting at 17% for Tier 3 preferred brands and up to 40% for Tier 4 non-preferred drugs depending on whether you use standard or preferred services. Specialty drugs in Tier 5 carry a 27% coinsurance for a one-month supply across all pharmacy and mail-order options. Utilizing preferred pharmacies and preferred mail-order services consistently offers the lowest out-of-pocket costs under this plan.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan provides affordable core medical coverage with no copays and no coinsurance for primary care visits, routine preventive care, and home health services. Specialist visits require a $35 copay, while emergency room services have a $120 copay and ground ambulance transport costs a $250 copay. For hospital care, inpatient acute stays require a $400 copay for days one through six, and outpatient hospital services range from no copay up to a $325 copay. Members also benefit from essential supplemental services, including routine dental, vision, and hearing exams with no copays. The plan features a $100 annual allowance for select eyewear and a $60 quarterly allowance for over-the-counter items with no copay. Other specialized needs, such as durable medical equipment and dialysis, are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Basic (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization and referrals are required. Patients pay a $400 copay for days 1-6 of acute stays and a $324 copay for days 1-5 of psychiatric stays, with no copay for subsequent days. 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 copays ranging from $0 to $325 for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $75 copay per session and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is 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 air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. Transportation services are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Basic (HMO) covers emergency services with a $120 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $35 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $120 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Basic (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Other covered services include occupational therapy for a $35 copay, physical and speech therapy for a $40 copay, and mental health services for a $30 copay with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Basic (HMO) covers Preventive Services with no copay and no coinsurance for annual physical exams, fitness benefits, remote access technologies, kidney disease education, and glaucoma screenings. This benefit is partially covered, as 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 and bathroom safety devices, and counseling are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Basic (HMO) covers hearing exams with no coinsurance, requiring a $35 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Hearing aid benefits are partially covered with no coinsurance and a copay of $699 to $999 for up to two prescription devices per year, while 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 no copay and no coinsurance for routine eye exams (one per year) and select eyewear, which has a $100 annual maximum. Covered eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, while other eye exam services, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance. Preventive care, including two oral exams, two cleanings, and one dental X-ray per year, is available with no copay and no coinsurance, though orthodontic, restorative, endodontic, periodontic, and fluoride services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Basic (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, have no copay and coinsurance ranging from no coinsurance up to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Blue Cross Medicare Advantage Basic (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Basic (HMO) with no copays, though prior authorization is required for all categories. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes are subject to a 20% coinsurance, while diabetic supplies range from no coinsurance to a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Basic (HMO), requiring referrals and prior authorization. Diagnostic services feature no coinsurance with a $5 copay for lab tests and a $0 to $50 copay for procedures, while radiological services range from no copay for X-rays and diagnostic radiology to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home health services are covered by Blue Cross Medicare Advantage Basic (HMO) with no copay and no coinsurance, although prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Blue Cross Medicare Advantage Basic (HMO) plan with no coinsurance, though prior authorization and referrals are required. While some services are covered, standard cardiac rehabilitation with a $30 copay, intensive cardiac rehabilitation with a $30 copay, pulmonary rehabilitation with a $15 copay, and supervised exercise therapy for PAD with a $25 copay are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and days 50 through 100, but a $218 daily copay applies for days 21 through 49, and additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are partially covered by Blue Cross Medicare Advantage Basic (HMO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $60 allowance every three months. Acupuncture, meal benefits, and Naloxone are not covered under this benefit.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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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