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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 2025, 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 Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4750.00 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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $350, as well as coverage for ambulance, emergency, and primary care services with copays, including some services with no copay. Additional benefits include coverage for preventive, hearing, vision, and dental services, with some services having no copay. The plan also covers home health, skilled nursing facility, and home infusion services. Other covered services include diagnostic and radiological services, with copays and coinsurance depending on the type of service.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a copay of $350 for days 1-7 and no copay for days 8-90, while Inpatient Hospital Psychiatric has a copay of $295 for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays, additional days, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $325 copay, Observation Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with a $250 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $75 copay, and Outpatient Blood Services with no copay. Prior authorization and/or a doctor referral may be required.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Basic (HMO) plan, requiring prior authorization and a doctor's referral. The copay for this benefit is $35.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage also have a $125 copay; however, Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay, with prior authorization and a referral required. Physician Specialist Services have a $17 copay. Mental Health Specialty Services, Individual and Group Sessions, have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay, and require prior authorization and a referral. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $30 copay, and require prior authorization and a referral.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, Annual Physical Exams with no copay, and additional preventive services including Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, all with no copay. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers hearing exams for a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but prescription hearing aids - 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 and eyewear. Eye exams have no copay, and include routine eye exams. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, but eyeglass frames and lenses are limited to one per year and there is a combined maximum plan benefit of $150 every year; eyeglass frames and upgrades are not covered.
Dental Services See details
Dental Services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan, with a $35 copay for Medicare Dental Services. Oral exams, dental x-rays, and prophylaxis (cleaning) have no copay, with oral exams and cleaning limited to 2 visits per year, and x-rays limited to 1 per year. Fluoride treatment and orthodontics are not covered, while restorative services and adjunctive general services have no coinsurance, endodontics, removable prosthodontics, maxillofacial prosthetics, and fixed prosthodontics have 20% coinsurance, and periodontics and oral and maxillofacial surgery have 0% - 20% coinsurance.
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 with prior authorization and a doctor's referral, and require 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Blue Cross Medicare Advantage Basic (HMO) plan. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have between 0-35% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 35% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services requiring a doctor's referral and prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Basic (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 Blue Cross Medicare Advantage Basic (HMO) plan. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. There is no copay for days 1-20, a $214 copay for days 21-39, and no copay for days 40-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $50 every three months. 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 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.
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