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Blue Cross Medicare Advantage Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Value (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 Value (HMO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Value (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in San Antonio, El Paso, & South Texas Markets. 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 Value (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 Value (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 Value (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 Value (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies. After your total drug costs reach $2000, you will enter the next coverage phase.
Additional Benefits
The Blue Cross Medicare Advantage Value (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and ambulance services also have copays. You will find no copays for services such as primary care visits, preventive services, home health services, and some vision and dental services. Additional benefits include coverage for hearing aids, vision care, and dental services. Hearing aids have a copay, and the plan also covers eyewear with no copay. The plan also provides coverage for dental services with varying copays and coinsurance depending on the specific services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, you pay a $200 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays, upgrades, and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, require prior authorization and a doctor referral and have a $300 copay. Ambulatory Surgical Center (ASC) Services require prior authorization and a doctor referral and have a $225 copay, while Outpatient Substance Abuse Services have a $75 copay for both individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Value (HMO) plan, requiring prior authorization and a doctor's referral. The copay for this benefit is $20.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Value (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $45 copay, and all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Value (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay. Physician specialist services have a $20 copay, while mental health and psychiatric services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay, additional telehealth benefits have no copay, and Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
Preventive services include no copay for an annual physical exam, Medicare-covered preventive services, and additional preventive services such as glaucoma screening, diabetes self-management training, and EKG following a Welcome Visit. Some preventive services are not covered, including health education, in-home safety assessments, and medical nutrition therapy.
Hearing Services See details
Hearing services are covered, including hearing exams and prescription hearing aids. Hearing exams have a $35 copay, routine hearing exams have no copay, and the plan covers fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with no copay, and eyewear with no copay. Eyeglass lenses and eyeglass frames are covered, with one pair covered every year. Contact lenses are covered, and there is a combined maximum of $150 per year for eyewear. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, and dental x-rays and prophylaxis (cleaning) with no copay. Other dental services include restorative services and adjunctive general services with no coinsurance, endodontics, prosthodontics (removable), maxillofacial prosthetics, and prosthodontics (fixed) with 20% coinsurance, as well as periodontics and oral and maxillofacial surgery with coinsurance between 0% and 20%. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Blue Cross Medicare Advantage Value (HMO) plan. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%.
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 $250, 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 by the Blue Cross Medicare Advantage Value (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 covered, but no copay or coinsurance information is provided. However, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Blue Cross Medicare Advantage Value (HMO) plan, but require prior authorization and a doctor 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 include coverage for Over-the-Counter (OTC) items with no copay, and a meal benefit with no copay, but 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. OTC items have a maximum plan benefit coverage amount of $25.00 every three months.
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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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