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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 Houston, Austin, & West Texas Markets. 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:
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Drug Coverage
The Blue Cross Medicare Advantage Value (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Cross Medicare Advantage Value (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay, with outpatient services, including substance abuse and blood services, having copays as well. Emergency and urgent care visits have copays, and transportation services have no copay with limitations on the number of trips. The plan includes coverage for primary care, preventive care, and hearing and vision services, often with no copay. Dental services and medical equipment are covered with coinsurance, while home health services have no copay. The plan also includes coverage for home infusion, dialysis, and skilled nursing facilities, with associated copays or coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, require a $250 copay. Ambulatory Surgical Center (ASC) Services have a $125 copay. Outpatient Substance Abuse Services have a $75 copay for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Blue Cross Medicare Advantage Value (HMO) plan, with a $35 copay. Prior authorization and a doctor referral are required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation Services have no copay, and include 12 one-way trips per year to a plan-approved health-related location via rideshare or medical transport. 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 under the Blue Cross Medicare Advantage Value (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $135 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, and Additional Telehealth Benefits have no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $15 copay, while Individual and Group Sessions for Mental Health and Psychiatric Services have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Opioid Treatment Program Services have a minimum and maximum copay of $30. Podiatry Services are not covered.
Preventive Services See details
The Blue Cross Medicare Advantage Value (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits and remote access technologies, are covered with no copay. Some services, such as health education, in-home safety assessments, and others, are not covered.
Hearing Services See details
Hearing services are covered by the Blue Cross Medicare Advantage Value (HMO) plan, including hearing exams with a $35 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a copay between $699 and $999. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay. Eyewear, including contact lenses, eyeglass lenses, and eyeglass frames, have no copay, and a combined maximum plan benefit of $150.00 every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services include Medicare dental services with a $35 copay, oral exams with no copay, dental x-rays and prophylaxis (cleaning) with no copay, and other dental services. The plan does not cover fluoride treatment, implant services, or orthodontics, but covers restorative services and adjunctive general services with no coinsurance, endodontics, prosthodontics, removable, maxillofacial prosthetics and prosthodontics, fixed with 20% coinsurance, and periodontics and oral and maxillofacial surgery with coinsurance between 0% and 20%. Orthodontic Services has a maximum benefit of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Value (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have 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 include coverage for all diagnostic services with a copay that ranges from $0 to $100, and lab services with no copay. Diagnostic Radiological Services have a copay up to $300, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation 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, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $25 every three months. Acupuncture, Meal Benefit, 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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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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