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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.
Blue Cross Medicare Advantage Basic (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Houston HMO. This plan received an overall rating of 3 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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $450.00 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 $6750.00 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 Cross Medicare Advantage Basic (HMO) plan features an annual drug deductible of $450. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, with copays starting at just $1 at preferred locations compared to $6 at standard pharmacies. For higher-tier medications, costs are based on coinsurance percentages rather than flat copayments. Tier 3 preferred brand drugs require a 17% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 38% coinsurance. Specialty drugs in Tier 5 require 27% coinsurance for a one-month supply regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For more specialized care, beneficiaries will pay a $32 copay for specialist visits, a $125 copay for emergency room visits, and inpatient hospital stays that feature set daily copays with no coinsurance. Outpatient services, including ambulatory surgical center visits, are also covered with no copay and no coinsurance. Routine hearing and vision exams are covered with no copay, while prescription hearing aids require copays ranging from $699 to $999 with no coinsurance. For recovery and support, home health services feature no copay, and skilled nursing facility stays offer no copay for days 1 through 20 and days 40 through 100. Additionally, medical equipment, dialysis services, and Part B drugs generally carry a 20% coinsurance with no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Basic (HMO) partially covers inpatient hospital care with no coinsurance. Acute stays require a $395 daily copay for days 1-7 and no copay for additional days, while psychiatric stays require a $295 daily copay for days 1-6 and no copay for days 7-90; however, 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, including outpatient hospital services with a $0 to $375 copay and observation services with a $375 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Basic (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Both prior authorization and a referral are required to receive this covered benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Basic (HMO) covers ambulance services with a $295 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Basic (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are partially covered, offering emergency and urgent care for a $125 copay and no coinsurance, while worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Basic (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $32 copay and no coinsurance. Therapy services, including physical, occupational, mental health, and psychiatric treatments, carry copays of $30 to $35 and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Basic (HMO) offers partially covered preventive services with no copay and no coinsurance for covered options such as annual physicals, kidney disease education, fitness benefits, and remote access technologies. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, and nutritional/dietary benefits.
Hearing Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers hearing services, offering Medicare-covered exams for a $35 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from $699 to $999, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers eye exams, offering one routine exam per year with no copay and no coinsurance, while other eye exam services are not covered. For eyewear, some services are covered but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered in practice.
Dental Services See details
Blue Cross Medicare Advantage Basic (HMO) partially covers dental services, offering coverage only for Medicare-covered dental care with a $35 copay and no coinsurance. Other dental services, including preventive cleanings, exams, x-rays, and comprehensive or orthodontic treatments, are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Basic (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
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
Blue Cross Medicare Advantage Basic (HMO) covers medical equipment with no copays, though prior authorization is required for these services. Beneficiaries will pay a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, while diabetic supplies and therapeutic shoes carry a coinsurance ranging from no coinsurance up to 35%.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Basic (HMO) covers diagnostic and radiological services, requiring prior authorization and referrals for all services. Lab services feature no copay and no coinsurance, diagnostic procedures have a copay of $0 to $100 with no coinsurance, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
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.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Basic (HMO) covers some cardiac rehabilitation services with no coinsurance, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered. Prior authorization and referrals are required for any covered services.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Basic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral. There is no copay for days 1 through 20 and days 40 through 100, a $218 copay per day for days 21 through 39, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are not covered under the Blue Cross Medicare Advantage Basic (HMO) plan, as acupuncture, over-the-counter items, and meal benefits are all excluded from coverage.
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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.
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