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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 El Paso/South TX 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 $3700.00 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 features a $450 annual drug deductible and offers affordable options for generic medications. Tier 1 preferred generic drugs have no copay when filled through preferred pharmacies or preferred mail order services. Tier 2 generic drugs are also highly accessible, with copays starting as low as $1 at preferred locations. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require an 18% coinsurance at preferred pharmacies compared to 22% at standard pharmacies, while Tier 4 non-preferred drugs carry a 39% to 41% coinsurance. Specialty drugs in Tier 5 require a 27% coinsurance across all pharmacy and mail order options for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Basic (HMO) plan offers affordable coverage with predictable cost-sharing for essential medical services. Members benefit from no copay for primary care physician visits, while specialist visits require a $26 copay, both with no coinsurance. Inpatient hospital stays feature no coinsurance and a $325 daily copay for the first six days, followed by no copay for additional days. Supplemental care includes routine dental, vision, and hearing exams with no copay, as well as a $100 annual allowance for eyewear. Additionally, members receive a $60 quarterly allowance for over-the-counter items and home health services with no copay. Emergency room visits carry a $135 copay, which is waived if you are admitted to the hospital within three days.
Inpatient Hospital See details
Blue Cross Medicare Advantage Basic (HMO) covers inpatient acute hospital stays with no coinsurance and a $325 daily copay for days 1 to 6, with no copay for additional days. Inpatient psychiatric care is covered with no coinsurance and a $300 daily copay for days 1 to 6 (no copay for days 7 to 90), though 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 ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services have a copay of $0 to $300, observation services require a $300 copay per stay, and outpatient substance abuse sessions have a $75 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Blue Cross Medicare Advantage Basic (HMO) with a $30.00 copay and no coinsurance. Prior authorization and a referral are required for this benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Basic (HMO) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Some transportation services are covered, though transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Basic (HMO) covers emergency services with a $135 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, and urgent care with a $30 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $135 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Basic (HMO) features primary care physician visits and telehealth services with no copay and no coinsurance, while specialist visits require a $26 copay and no coinsurance. Therapy services carry a $50 copay with no coinsurance, mental health services have a $35 copay with no coinsurance, and 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 services, including annual physical exams, fitness benefits, remote access technologies, kidney disease education, and select screenings. However, several additional supplemental benefits are not covered, such as health education, nutritional or dietary benefits, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Blue Cross Medicare Advantage Basic (HMO) covers hearing services with a $35 copay for Medicare-covered exams and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $699 and $999 for up to two devices per year, 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 vision services with no copay, no coinsurance, and no deductible, offering one routine eye exam per year and up to $100 annually for contact lenses, eyeglass lenses, and frames. Other eye exam services, eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Basic (HMO) dental services are partially covered, offering Medicare-covered dental care for a $35.00 copay and no coinsurance. Preventive care, including two annual cleanings, two annual oral exams, and one annual dental x-ray, is available with no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, prosthodontic, implant, orthodontic, and oral surgery services 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. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Basic (HMO) plan 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. Durable medical equipment, prosthetics, and medical supplies carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 35% coinsurance, and diabetic therapeutic shoes or inserts require a 35% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Basic (HMO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic tests with a copay ranging from $0 to $100. Covered radiological services feature no copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic services, with referrals and prior authorizations required.
Home Health Services See details
Blue Cross Medicare Advantage Basic (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Medicare Advantage Basic (HMO) with no coinsurance, though prior authorization and referrals are required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, requiring a $30 copay for cardiac, intensive cardiac, and SET for PAD services, and a $20 copay for pulmonary rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Blue Cross Medicare Advantage Basic (HMO) with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and days 40 through 100, a $218 daily copay for days 21 through 39, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Blue Cross Medicare Advantage Basic (HMO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $60 allowance every three months. Acupuncture, meal benefits, and naloxone are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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