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Blue adVantage Reliance (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue adVantage Reliance (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue adVantage Reliance (HMO-POS) in 2025, please refer to our full plan details page.
Blue adVantage Reliance (HMO-POS) is a HMO-POS plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in State of Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Blue adVantage Reliance (HMO-POS) 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 adVantage Reliance (HMO-POS).
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 adVantage Reliance (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.80. You must continue to pay paying your reduced 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 $4100.00 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 adVantage Reliance (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $12 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium is $55.60.
Additional Benefits
The Blue adVantage Reliance (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient hospital stays with copays, outpatient services with varying copays, and emergency services with a $125 copay. You can also expect coverage for primary care with no copay, preventive services, and hearing and vision services with no copays for routine exams. Dental services are covered, with a $2,400 annual maximum benefit and no copays for many services. Additional benefits include ambulance services with copays, home infusion services, and dialysis services with coinsurance. The plan also provides coverage for medical equipment with 20% coinsurance, diagnostic and radiological services with varying copays and coinsurance, home health services with no cost, and skilled nursing facility services with copays. However, some services like transportation services, additional hours of care, and certain dental, vision, and medical equipment services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $205 copay for days 1-10 and no copay for days 11-90. For Inpatient Hospital Psychiatric, you pay a $225 copay for days 1-8 and no copay for days 9-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and Non-Medicare-covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Blue adVantage Reliance (HMO-POS) plan, including Outpatient Hospital Services with a copay of $0-$250, Observation Services with a $205 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $0-$30 copay for individual and group sessions, and Outpatient Blood Services. Prior authorization is required for many services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue adVantage Reliance (HMO-POS) plan, but requires prior authorization. You will have a $60 copay for this service.
Ambulance and Transportation Services See details
The Blue adVantage Reliance (HMO-POS) plan covers ambulance services with no coinsurance, but has a $250 copay for ground ambulance services and a $260 copay for air ambulance services. 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 under the Blue adVantage Reliance (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $40 copay; all three have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Blue adVantage Reliance (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $0 and $35, and physician specialist services with a copay between $15 and $30. The plan also covers mental health specialty services, with a copay between $0 and $30 for individual and group sessions, and other health care professional services with a coinsurance of 20% and a copay between $0 and $30. Psychiatric services, including individual and group sessions, are covered with a copay between $0 and $30. Physical therapy and speech-language pathology services are covered with a copay between $0 and $35, and additional telehealth benefits are covered with a copay between $0 and $35. Opioid treatment program services are covered with a $40 copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the Blue adVantage Reliance (HMO-POS) plan. Additional services like Personal Emergency Response System (PERS), Home-Based Palliative Care, and Fitness Benefits are also covered. However, services such as Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
The Blue adVantage Reliance (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1100 per year with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are covered with no copay.
Vision Services See details
Vision Services include eye exams and eyewear benefits. Eye exams have a copay of $15-$30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $450 per year.
Dental Services See details
Dental services include a $2,400 annual maximum benefit, and cover oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery with no copay; however, maxillofacial prosthetics and orthodontics are not covered. Oral exams are limited to 2 visits per year, and dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are each limited to 1 visit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue adVantage Reliance (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Blue adVantage Reliance (HMO-POS) plan covers all diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $30, lab services with no copay, diagnostic radiological services with a copay up to $150, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with up to 20% coinsurance. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Blue adVantage Reliance (HMO-POS) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue adVantage Reliance (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $165.
Other Services See details
Other Services offered by the Blue adVantage Reliance (HMO-POS) plan are partially covered, with 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 not covered. Over-the-Counter (OTC) Items are covered, but does not cover all drugs on the CMS OTC list and does not offer Nicotine Replacement Therapy (NRT) or Naloxone coverage as a Part C OTC benefit.
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