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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 Dallas Metro Area. This plan received an overall rating of 3 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 $4100.00 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) plan has an enhanced alternative drug benefit. This plan has no deductible. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, you will pay a $10 copay at a preferred pharmacy and $20 at a standard pharmacy. For standard generic drugs, you will pay a $47 copay regardless of the pharmacy. For preferred brand drugs and non-preferred drugs, you will pay coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Value (HMO) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with a copay, and outpatient services with a copay. Many services have no copay, including primary care visits, preventive services, eye exams, and home health services. Additional benefits include coverage for emergency services, ambulance services, hearing and vision services, and dental services, each with its own cost structure. The plan also provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facility services, often with a coinsurance or copay. There are also several services that are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you'll pay a $250 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered, with a $300 copay. Observation Services have a $300 copay. Ambulatory Surgical Center (ASC) Services have a $225 copay. 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 with a $35 copay, and requires prior authorization and a doctor referral.
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 $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, with a limit of 12 one-way trips per year, but transportation services to any health-related location are not covered.
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 $135 copay, while Urgently Needed Services have a $45 copay; 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, and chiropractic services with a $20 copay. Occupational therapy services have a $35 copay, while physician specialist services have a $16 copay. Mental health and psychiatric services have a $35 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits are covered with no copay, and opioid treatment program services have a $20 copay.
Preventive Services See details
Preventive Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan. Annual physical exams have no copay, and other services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit also have no copay.
Hearing Services See details
Hearing services are covered, including hearing exams. Hearing exams have a $35 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered. Prescription hearing aids (all types) have a copay between $699 and $999, depending on the specific hearing aid.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, all with no copay, but eyeglass frames and lenses are limited to one per year, and there is a combined maximum of $100 per year for all eyewear. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Value (HMO) plan covers dental services with a $35 copay for Medicare dental services. Oral exams and dental X-rays have no copay, while prophylaxis (cleaning) has no copay and is limited to 2 visits per year. Fluoride treatments and orthodontics are not covered, and some other services have a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 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. This plan requires prior authorization and a doctor's referral, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 35%, and Diabetic Therapeutic Shoes/Inserts have a 35% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a 20% coinsurance, 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 the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Value (HMO) plan, with prior authorization and a doctor's referral required. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39.
Other Services See details
The Blue Cross Medicare Advantage Value (HMO) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $25 every three months. Acupuncture, meal benefits, 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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