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BlueMedicare Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Premier (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Premier (HMO) in 2025, please refer to our full plan details page.
BlueMedicare Premier (HMO) is a HMO plan offered by USAble Mutual Insurance Company available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare 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 BlueMedicare 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 BlueMedicare Premier (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 a $100.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 BlueMedicare Premier (HMO) plan has a $100 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance for your medications, depending on the drug tier and pharmacy used. For example, Tier 1 preferred generic drugs have a $5 copay at standard or mail-order pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy (LIS), you will have no copay for Part D drugs.
Additional Benefits
The BlueMedicare Premier (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $375 copay for days 1-5, and no copay for days 6-90. Outpatient services have a copay, and emergency services have a $125 copay. Primary care visits, preventive services, and many dental services have no copay. The plan also includes coverage for hearing and vision services, with copays for exams and no copay for eyewear. Prescription hearing aids are covered up to a $1,000 maximum every three years with no copay. Additionally, the plan covers home health services with no copay, and offers coverage for various services like ambulance, skilled nursing facility, and diagnostic services, with associated copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $375 for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital acute and psychiatric, and non-Medicare-covered stays for inpatient hospital acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a copay of $325.00. Ambulatory Surgical Center (ASC) Services have a copay of $250.00, while individual and group sessions for outpatient substance abuse have a copay of $30.00. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $85 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Premier (HMO) plan. Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by BlueMedicare Premier (HMO). Emergency Services have a $125 copay, and Urgently Needed Services have a $30 copay, both with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a 20% coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Premier (HMO) plan covers primary care services with no copay, chiropractic services with a $15 copay, occupational therapy with a $40 copay, specialist visits with a $35 copay, mental health services with a $35 copay, podiatry services with a $35 copay, other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $40 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, including annual physical exams with no copay. Additional preventive services, as well as Kidney Disease Education Services, and Other Preventive Services are also covered, with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
The BlueMedicare Premier (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a $1,000 maximum every three years with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, and eyewear with a $0 copay. Contact lenses, eyeglasses (lenses and frames), and upgrades are covered, but eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
The BlueMedicare Premier (HMO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, and fluoride treatment with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with a 20% coinsurance. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. There is a maximum plan benefit coverage of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Premier (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with no copay, diagnostic procedures/tests with up to 20% coinsurance, and lab services with up to 20% coinsurance. Radiological services include coverage for diagnostic radiological services with a copay up to $325, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered under the BlueMedicare 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 not covered by the BlueMedicare Premier (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 BlueMedicare Premier (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit, with no copay for either. Acupuncture, 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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