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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 2026, 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 Dallas/Northeast HMO. This plan received an overall rating of 2.5 out of 5 stars in 2026.
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 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 $4950.00 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 Value (HMO)
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Drug Coverage
The Blue Cross Medicare Advantage Value (HMO) prescription drug plan has an annual drug deductible of $450. For Tier 1 preferred generic drugs, you will have no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs cost just a $1 copay for a one-month supply at preferred locations compared to a $6 copay at standard pharmacies. Brand-name and specialty medications are covered under coinsurance. Tier 3 preferred brand drugs require a 17% coinsurance at preferred pharmacies and 20% at standard pharmacies, while Tier 4 non-preferred drugs carry 40% or 43% coinsurance. Tier 5 specialty drugs require a 27% coinsurance for a one-month supply regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Blue Cross Medicare Advantage Value (HMO) plan offers affordable coverage with no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. For specialist visits, members pay a low $28 copay with no coinsurance. If you require hospital services, outpatient care ranges from no copay up to a $395 copay with no coinsurance, while inpatient stays require a daily copay for the first few days and no coinsurance. This plan also includes essential dental, vision, and hearing benefits, featuring no copays for routine eye exams, dental cleanings, and hearing evaluations. Additionally, members benefit from no copays and no coinsurance for home health services, though durable medical equipment and dialysis require a twenty percent coinsurance. Note that some benefits like transportation, over-the-counter items, and cardiac rehabilitation are not covered under this plan.
Inpatient Hospital See details
Blue Cross Medicare Advantage Value (HMO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Covered acute stays require a $375 daily copay for days 1 through 6, while psychiatric stays require a $250 daily copay for days 1 through 5, with no copay for subsequent days under both benefits.
Outpatient Services See details
Outpatient services are covered by Blue Cross Medicare Advantage Value (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Medicare-covered outpatient hospital services require a copay of $0 to $395, observation services cost $375 per stay, and outpatient substance abuse sessions carry a $75 copay.
Partial Hospitalization See details
Blue Cross Medicare Advantage Value (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Value (HMO) covers ground ambulance services with a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Blue Cross Medicare Advantage Value (HMO) plan are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency and urgent care are partially covered with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Value (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $28 copay with no coinsurance. Physical, occupational, speech, and mental health therapies require a $35 copay with no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Value (HMO) covers preventive services, including annual physical exams, kidney disease education, and fitness benefits, with no copay and no coinsurance. The benefit is partially covered because health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Value (HMO) partially covers hearing services with no deductibles or coinsurance, offering Medicare-covered exams for a $35 copay, and routine exams and fitting evaluations with no copay. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from $699.00 to $999.00, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Value (HMO) with no copay, no coinsurance, and no deductible for covered services, including one annual routine eye exam and a $100 yearly allowance for contact lenses, eyeglass lenses, and frames. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Value (HMO) dental services are partially covered, offering Medicare-covered dental care for a $35 copay and no coinsurance, and select preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Many services are not covered, including fluoride, orthodontics, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Value (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Blue Cross Medicare Advantage Value (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Blue Cross Medicare Advantage Value (HMO) covers medical equipment with no copays, though prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, 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
Diagnostic and radiological services are covered by Blue Cross Medicare Advantage Value (HMO) with prior authorization and referrals required. Lab services and outpatient X-rays feature no copay, diagnostic procedures carry a copay of $0 to $100 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Blue Cross Medicare Advantage Value (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Blue Cross Medicare Advantage Value (HMO) plan, as none of the sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Value (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 to 20 and days 40 to 100, a $218 daily copay for days 21 to 39, and no coverage for additional days beyond the standard 100-day Medicare limit.
Other Services See details
Other services, including acupuncture, over-the-counter (OTC) items, and meal benefits, are not covered by the Blue Cross Medicare Advantage Value (HMO) 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.
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