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Blue Cross Medicare Advantage Secure (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Secure (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 Secure (HMO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Secure (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Houston/Austin/Northwest 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 Secure (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 Secure (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 Secure (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 $4200.00 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 Secure (HMO) plan features an annual drug deductible of $450. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail order services, while standard options require a $5 copay for a one-month supply. Tier 2 generic medications cost as low as 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 rates rather than flat copays. Tier 3 preferred brands require an 18% coinsurance at preferred pharmacies and 22% at standard pharmacies, while Tier 4 non-preferred drugs range from 38% to 41% coinsurance. Tier 5 specialty drugs incur a flat 27% coinsurance across all pharmacy and mail-order options for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Secure (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, routine physicals, and home health services. Specialist visits require a $22 copay, while inpatient hospital stays require a daily copay of $350 for days one through eight followed by no copay for the remaining days. Emergency room visits carry a $135 copay, which is waived if you are admitted, and urgent care is available for a $40 copay. Routine dental cleanings, annual routine eye exams, and routine hearing exams are all covered with no copay, and the plan includes a $100 annual limit for eyewear. While diagnostic lab work and outpatient X-rays also feature no copay, services like durable medical equipment and dialysis require a 20% coinsurance. Skilled nursing facility care is also accessible, featuring no copay for the first 20 days and for days 40 through 100.
Inpatient Hospital See details
Blue Cross Medicare Advantage Secure (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a daily copay of $350 for days 1 to 8 of acute stays and $295 for days 1 to 6 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization and referrals are required, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Secure (HMO) covers outpatient services with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $75 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Blue Cross Medicare Advantage Secure (HMO) with a $35.00 copay and no coinsurance, though prior authorization and a referral are required.
Ambulance and Transportation Services See details
Ambulance services are covered by Blue Cross Medicare Advantage Secure (HMO) with prior authorization, requiring a $295 copay and coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Secure (HMO) covers emergency services with a $135 copay (waived if admitted to the hospital within 3 days) and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered with a $135 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Secure (HMO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $22 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies carry a $35 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Secure (HMO) provides partial coverage for preventive services, offering covered options like annual physicals, fitness benefits, and select screenings with no copay and no coinsurance. Several supplemental preventive services are not covered, including health education, nutritional benefits, in-home safety assessments, personal emergency response systems, and counseling.
Hearing Services See details
Hearing services are covered by Blue Cross Medicare Advantage Secure (HMO), featuring Medicare-covered exams for a $35 copay and routine exams or fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699.00 to $999.00, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Blue Cross Medicare Advantage Secure (HMO) features partially covered vision services with no copay, no coinsurance, and no deductible for covered benefits. Covered services include one routine eye exam per year and eyewear (contact lenses, eyeglass lenses, and frames) up to a $100 annual limit, while other eye exams, packaged eyeglasses (lenses and frames), and upgrades are not covered.
Dental Services See details
Blue Cross Medicare Advantage Secure (HMO) dental services are partially covered, featuring Medicare-covered dental care for a $35 copay and no coinsurance, alongside preventive exams, cleanings, and x-rays with no copay and no coinsurance. However, fluoride treatments, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Secure (HMO) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance up to 20%, while Part B insulin drugs have a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Secure (HMO) plan 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 Secure (HMO) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts carry a coinsurance ranging from no coinsurance up to 35%.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Secure (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $100 copay for diagnostic tests. Covered radiological services include outpatient X-rays and diagnostic radiological services with no copay, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are fully covered under the Blue Cross Medicare Advantage Secure (HMO) plan with no copay and no coinsurance. Members will need to obtain a referral and prior authorization before receiving these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Blue Cross Medicare Advantage Secure (HMO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Secure (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization and a referral but no prior three-day hospital stay. There is no copay for days 1 through 20 and days 40 through 100, while days 21 through 39 require a $218 copay.
Other Services See details
Other services are not covered under the Blue Cross Medicare Advantage Secure (HMO) plan, including acupuncture, over-the-counter (OTC) items, and meal benefits.
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