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Blue Medicare Advantage HMO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage HMO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Advantage HMO (HMO) in 2025, please refer to our full plan details page.
Blue Medicare Advantage HMO (HMO) is a HMO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Blue Medicare Advantage HMO (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 Medicare Advantage HMO (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 Medicare Advantage HMO (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 $4000.00 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 Medicare Advantage HMO (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, generic drugs have a $12 or $47 copay, while brand-name drugs have 50% coinsurance. 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 Part D costs are $0.
Additional Benefits
The Blue Medicare Advantage HMO (HMO) plan offers a range of benefits, including inpatient hospital stays with a $350 copay for the first six days, and no copay for days 7-90. This plan also covers outpatient services, such as outpatient hospital services, with copays ranging from $35 to $350, and primary care with no copay. Additional benefits include hearing and vision services, with hearing exams and routine eye exams with no copay, and coverage for hearing aids and eyewear. The plan also provides dental coverage, home health services with no copay, and coverage for medical equipment, all with varying copays and coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $35-$350, Observation Services with a $300 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, Outpatient Substance Abuse Services with a $35 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Medicare Advantage HMO (HMO) plan with a $60 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Medicare Advantage HMO (HMO) plan. Ground and Air Ambulance services have a $300 copay, and there is no coinsurance. 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 Medicare Advantage HMO (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage has a $120 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Medicare Advantage HMO (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy with a $35 copay. The plan also covers physician specialist services, mental health specialty services, psychiatric services, physical therapy, and speech-language pathology services with a $35 copay. Additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have no copay. Podiatry services are not covered.
Preventive Services See details
The Blue Medicare Advantage HMO (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as health education, in-home safety assessments, and others, are not covered.
Hearing Services See details
The Blue Medicare Advantage HMO (HMO) plan covers hearing exams with no copay and routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription hearing aids (all types) are covered up to $500 per year, and OTC hearing aids are covered up to $55 per ear every three months, while some Prescription Hearing Aid sub-services are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$35, and routine eye exams covered once per year. Eyewear benefits include contact lenses, eyeglass lenses, eyeglass frames and upgrades. Contact lenses are covered once per year with a maximum plan benefit coverage amount of $150, and eyeglass frames are covered once per year with a maximum plan benefit coverage amount of $150. Eyeglasses (lenses and frames) are not covered.
Dental Services See details
The Blue Medicare Advantage HMO (HMO) plan covers dental services, with a $35 copay for Medicare dental services. Other dental services include oral exams, dental x-rays, cleaning, and fluoride treatment, and the plan also covers restorative services, endodontics, prosthodontics, fixed, and oral and maxillofacial surgery with varying coinsurance amounts. Orthodontic Services has a maximum benefit of $1500 per year. The plan does not cover adjunctive general services, maxillofacial prosthetics, implant services, or orthodontics.
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 under the Blue Medicare Advantage HMO (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Blue Medicare Advantage HMO (HMO) plan. Durable Medical Equipment (DME) has no copay and a coinsurance of 0% to 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, with a 20% coinsurance for Prosthetic Devices and Medical Supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $35 copay, Lab Services with a $5 copay, Diagnostic Radiological Services with a $150 copay, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $20 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Advantage HMO (HMO) 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 Medicare Advantage HMO (HMO) plan. This 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, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Advantage HMO (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $55 every three months, and a meal benefit with no copay. 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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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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