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BlueMedicare Classic Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Classic Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Classic Plus (HMO) in 2025, please refer to our full plan details page.
BlueMedicare Classic Plus (HMO) is a HMO plan offered by USAble Mutual Insurance Company available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare Classic Plus (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 BlueMedicare Classic Plus (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 BlueMedicare Classic Plus (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. Additionally, this plan comes with a Part B Premium reduction of $4.00. You must continue to pay paying your reduced 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 $250.00 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 $6200.00 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 BlueMedicare Classic Plus (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs at a standard pharmacy, you'll pay a $5 or $47 copay. For brand-name drugs, you'll pay 36% coinsurance, while non-preferred drugs have a 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Classic Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays for specific services like hospital visits and substance abuse treatment, but blood services have no copay. Emergency and urgently needed services have copays, and primary care visits are free, with copays for specialist visits and other services. Preventive services and routine hearing and vision exams have no copay, and prescription hearing aids are covered up to a maximum, with vision and dental services including copays and coinsurance. Home health services, medical equipment, and some diagnostic services have coinsurance, while other services like dental and dialysis services have varying costs. The plan also includes benefits for over-the-counter items and meals with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $375 for days 1-5 and no copay for days 6-90. Additional days and non-Medicare-covered stays 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, and outpatient substance abuse services with a $40 copay per individual or group session. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Classic Plus (HMO) plan, but requires prior authorization. You will have a copay of $85 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Classic Plus (HMO) plan, including ground ambulance services with a $325 copay, and air ambulance services with 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by BlueMedicare Classic Plus (HMO), with a $125 copay and no coinsurance, while urgently needed services have a $30 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a 20% coinsurance, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Classic Plus (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, and physician specialist services with a $35 copay. Mental health, podiatry, other health care professional, psychiatric, and opioid treatment program services have varying copays, while physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have no copay.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services with no copay, and also covers an annual physical exam with no copay. Additional preventive services are covered with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Other services such as 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 benefits, home-based palliative care, 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
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $1000 every three years, with no copay for all types of prescription hearing aids except inner ear, outer ear, and over the ear, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$35, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and upgrades, have no copay, but there is a combined maximum benefit of $150 per year. Eyeglass lenses and frames are not covered.
Dental Services See details
The BlueMedicare Classic Plus (HMO) plan covers dental services, with a $35 copay for Medicare dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered with no copay, but the plan has a maximum benefit of $3,500 per year. Restorative services, adjunctive general services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with 20% coinsurance, while endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Classic Plus (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The BlueMedicare Classic Plus (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests and lab services with a coinsurance of at most 20%, and outpatient X-ray services with no copay. Diagnostic radiological services have a copay of at most $325.00, and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Classic Plus (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Classic Plus (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Classic Plus (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services in the BlueMedicare Classic Plus (HMO) plan include coverage for Over-the-Counter (OTC) Items with no copay, and a Meal Benefit with no copay. 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.
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