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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 El Paso & South Texas. 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 $2000.00 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:
Sign up for Blue Cross Medicare Advantage Basic (HMO)
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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 depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while preferred brand drugs have a 31% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still have to pay 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 costs. Inpatient hospital stays have a copay of $100-$125 for the first six days, with no copay for the remaining days. Outpatient services have copays ranging from $0 to $200, and the plan covers emergency services with a $30-$135 copay. This plan includes no copay for primary care visits, preventive services, and some hearing and vision services. It also offers coverage for dental services, home health services, and certain medical equipment with varying copays and coinsurance. However, some services like cardiac rehabilitation and additional hours of care are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $100 for days 1-6 and no copay for days 7-90 for acute care, and a copay of $125 for days 1-6 and no copay for days 7-90 for psychiatric care. Additional days and non-Medicare-covered stays for inpatient psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $200 copay, ASC services have a $150 copay, and outpatient blood services have no copay. Outpatient substance abuse services have a copay of $75 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Basic (HMO) plan, with a $30 copay. Prior authorization and a doctor referral are required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan, including ground and air ambulance, as well as transportation to plan-approved health-related locations. Ground ambulance services have a copay of $295, while air ambulance services have a 20% coinsurance; transportation services to health-related locations have no copay for up to 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Emergency Services, Urgently Needed Services, and Worldwide Emergency Services, are covered by the Blue Cross Medicare Advantage Basic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $135 copay, while Urgently Needed Services have a $30 copay; all have no coinsurance. Worldwide Urgent Coverage also has a $135 copay, but 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, and chiropractic services with a $20 copay. Occupational therapy services have a $35 copay, while physician specialist services have an $11 copay. Mental health specialty services, psychiatric services, and Opioid Treatment Program Services have a $35 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Some additional preventive services, such as Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, are covered with no copay. Other services, such as health education, in-home safety assessments, and medical nutrition therapy, are not covered.
Hearing Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers hearing exams with 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 for the inner ear, outer ear, and over the ear are not covered, and over-the-counter hearing aids are not covered.
Vision Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams, contact lenses, eyeglass lenses, and eyeglass frames have no copay, while eyeglasses (lenses and frames) and upgrades are not covered. Contact lenses are unlimited, while eyeglass lenses and frames are limited to one per year, and the plan offers a combined maximum of $130 per year for eyewear.
Dental Services See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers dental services, including oral exams and dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Other dental services, such as fluoride treatment and orthodontics, are not covered. The plan also covers restorative services and adjunctive general services with no coinsurance, and oral and maxillofacial surgery with a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with 0-20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Basic (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Blue Cross Medicare Advantage Basic (HMO) plan covers medical equipment, including durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance, and durable medical equipment for use outside the home is not covered. Prosthetic devices have a coinsurance of 20%, while medical supplies have a 20% coinsurance. Diabetic supplies have a coinsurance between 0% and 35%, and diabetic therapeutic shoes/inserts have a 35% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under 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 these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Basic (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39. Additional days beyond Medicare coverage and non-Medicare covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay and 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. The plan offers OTC items with a maximum plan benefit coverage amount of $130 every three months.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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