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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.
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 $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. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you can expect to pay a $12 copay for a preferred generic drug at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Blue adVantage Reliance (HMO-POS) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency services. Many primary care services, such as primary care physician visits, have no copay, along with preventive services, and vision and dental services. The plan also covers hearing exams and hearing aids, and has no copays for home health services. Other benefits include ambulance services, partial hospitalization, and diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Blue adVantage Reliance (HMO-POS) plan, with a copay of $205 for days 1-10 and no copay for days 11-90 for Inpatient Hospital-Acute, and a copay of $225 for days 1-8 and no copay for days 9-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $250, observation services with a $205 copay, and ambulatory surgical center services with no copay. This plan also covers outpatient substance abuse services, individual sessions with a $30 copay, and group sessions with a $30 copay, as well as outpatient blood services with a waived three-pint deductible.
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
Ambulance and Transportation Services are covered under the Blue adVantage Reliance (HMO-POS) plan. Ground Ambulance Services have a $250 copay, and Air Ambulance Services have a $260 copay, but there is no coinsurance for either. 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 have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a $30 copay. Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services each have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Other Health Care Professional services have a copay between $0 and $30, and Opioid Treatment Program Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $35. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Blue adVantage Reliance (HMO-POS) plan covers preventive services, including annual physical exams, with no copay. The plan also covers Personal Emergency Response Systems, Home-Based Palliative Care, and Fitness Benefit with no copay. Some services, such as Health Education, In-Home Safety Assessments, Medical Nutrition Therapy, 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 (all types) are covered 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. Eye exams have a $30 copay, while routine eye exams are covered with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum plan benefit of $450 per year.
Dental Services See details
Dental services are covered, with a maximum benefit of $2,400 per year. 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 are covered with no copay. Maxillofacial prosthetics 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 a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Blue adVantage Reliance (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, are covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay of $0-$30 for diagnostic procedures/tests and a copay of $0 for lab services. Diagnostic Radiological Services have a copay up to $150, while Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue adVantage Reliance (HMO-POS) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue adVantage Reliance (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $165 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are partially covered under the Blue adVantage Reliance (HMO-POS) plan, 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.
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