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Blue Cross Medicare Advantage Core (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Core (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 Core (HMO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Core (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in San Antonio/South TX/El Paso 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 Core (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 Core (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 Core (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 $4900.00 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 Core (HMO) plan features a $450 annual drug deductible and offers competitive cost-sharing rates across five drug tiers. For Tier 1 preferred generics, members enjoy no copay when using a preferred pharmacy or preferred mail order service, while standard pharmacies charge copays starting at $5. Tier 2 generics are also highly affordable, with copays as low as $1 for a one-month supply at preferred locations. Higher-tier medications transition to coinsurance, with Tier 3 preferred brands requiring 17% coinsurance at preferred pharmacies and 19% at standard pharmacies. Tier 4 non-preferred drugs carry a 38% to 40% coinsurance, while Tier 5 specialty drugs require a flat 27% coinsurance for a one-month supply. Utilizing preferred network pharmacies or preferred mail-order services consistently delivers the lowest out-of-pocket costs for members.
Additional Benefits
The Blue Cross Medicare Advantage Core (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and routine home health care. For specialized medical needs, members pay a $19 copay for specialist visits and a $125 copay for emergency services, which is waived if hospitalized. Inpatient hospital stays require no coinsurance but do feature daily copays, such as $375 per day for the first eight days of acute care. This plan also includes valuable supplemental benefits, featuring no copay or coinsurance for routine dental cleanings, annual eye exams, and up to $100 annually for eyewear. Routine hearing exams also have no copay, though prescription hearing aids require copays ranging from $699 to $999. For medical equipment and dialysis services, members can expect a 20% coinsurance with no copay, while over-the-counter items are covered with no copay up to a $25 quarterly limit.
Inpatient Hospital See details
Blue Cross Medicare Advantage Core (HMO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 8 of acute stays and a $200 daily copay for days 1 through 6 of psychiatric stays, with no copay for subsequent days. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and both services require prior authorization and referrals.
Outpatient Services See details
Blue Cross Medicare Advantage Core (HMO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital and observation services, a $300 copay for ambulatory surgical center services, and a $75 copay for outpatient substance abuse sessions. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Blue Cross Medicare Advantage Core (HMO) plan with a $20.00 copay and no coinsurance. Prior authorization and a referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Blue Cross Medicare Advantage Core (HMO), requiring prior authorization with a $295 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Other transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Core (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, and urgently needed services with a $45 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $125 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by Blue Cross Medicare Advantage Core (HMO), excluding chiropractic and podiatry services which are not covered. Covered primary care and telehealth services have no copay and no coinsurance, while specialist visits ($19 copay), psychiatric sessions ($35 copay), and therapy services ($50 copay) require no coinsurance.
Preventive Services See details
Blue Cross Medicare Advantage Core (HMO) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, and kidney disease education. Sub-services not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Blue Cross Medicare Advantage Core (HMO) partially covers hearing services with no coinsurance, offering Medicare-covered exams for a $35 copay, routine exams and fitting evaluations with no copay, and up to two prescription hearing aids per year for a $699 to $999 copay. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by Blue Cross Medicare Advantage Core (HMO) with no copay, no coinsurance, and no deductible for covered services, including one routine eye exam per year and up to $100 annually for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Core (HMO) covers Medicare-covered dental services for a $35 copay and no coinsurance, plus preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 0% to 20% coinsurance up to a $1,000 annual limit, though fluoride, implants, orthodontics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Core (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Core (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Core (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and therapeutic shoes. Diabetic supplies are also covered with no copay and a coinsurance ranging from no coinsurance to 20%, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Blue Cross Medicare Advantage Core (HMO) plan, requiring referrals and prior authorizations. Lab services feature no copay and no coinsurance, diagnostic procedures range from a $0 to $100 copay, and therapeutic radiological services require a minimum 20% coinsurance. Outpatient X-rays have no copay but require coinsurance, and diagnostic radiological services have copays starting at $0.
Home Health Services See details
Blue Cross Medicare Advantage Core (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Blue Cross Medicare Advantage Core (HMO) with no coinsurance, but require prior authorization and a referral. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require copayments between $20 and $30.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Core (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral. There is no copay for days 1 to 20 and days 40 to 100, but days 21 to 39 require a $218 daily copay, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Core (HMO) provides partial coverage for other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $25 limit every three months. Acupuncture and meal benefits are not covered under this plan.
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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.
* 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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