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Blue Cross Medicare Advantage Dental Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dental 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 Dental Value (HMO) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dental Value (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in TX Enhanced Dental 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 Dental 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 Dental 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 Dental 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 $615.00 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 $5200.00 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 Dental Value (HMO)
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Drug Coverage
The Blue Cross Medicare Advantage Dental Value (HMO) plan features an annual drug deductible of $615. During the initial coverage phase, members enjoy no copay for Tier 1 preferred generic drugs when using preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, with copayments starting at just $1 at preferred locations. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 17% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry coinsurance rates up to 36% and 25% respectively. Utilizing preferred pharmacies and mail-order services offers the most cost-effective path for filling prescriptions under this plan.
Additional Benefits
The Blue Cross Medicare Advantage Dental Value (HMO) plan offers robust healthcare coverage featuring no copay and no coinsurance for primary care visits, telehealth, annual physicals, and home health services. For specialized medical needs, members pay no coinsurance and low copays, including a $15 to $50 copay for specialists, a $130 copay for emergency room visits, and no copay for laboratory services. Hospital stays are covered with no coinsurance, requiring a $390 daily copay for days one through six of acute inpatient care and up to a $375 copay for outpatient hospital services. This plan also delivers valuable supplemental benefits with no deductibles, including routine vision exams at no copay and an annual $100 eyewear allowance. Dental coverage features no copay and 0% to 20% coinsurance for preventive and comprehensive services up to a generous $3,000 yearly limit. Additionally, members benefit from routine hearing exams with no copay, a $70 quarterly over-the-counter item allowance, and home infusion services with no copay.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dental Value (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $390 daily copay for days 1 through 6 of acute stays and a $250 daily copay for days 1 through 5 of psychiatric stays, with no copay for subsequent covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Blue Cross Medicare Advantage Dental Value (HMO) with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $375, observation services have a $375 copay per stay, and outpatient substance abuse sessions carry a $75 copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Blue Cross Medicare Advantage Dental Value (HMO), requiring prior authorization and a $275 copay for ground ambulance services alongside a 20% coinsurance for air ambulance services. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dental Value (HMO) covers emergency services with a $130 copay, which is waived if admitted within 3 days, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Dental Value (HMO) covers primary care provider visits and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, and mental health services are covered with no coinsurance and copays ranging from $15 to $50, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by the Blue Cross Medicare Advantage Dental Value (HMO) with no copay and no coinsurance for covered benefits, which include annual physicals, fitness benefits, and kidney disease education. While essential screenings and remote access technologies are fully covered at no cost, several supplemental services like health education, weight management, and in-home support are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Dental Value (HMO) covers hearing services with no deductible, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with copays between $699 and $999 and no coinsurance, while inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Blue Cross Medicare Advantage Dental Value (HMO) with no copays, no coinsurance, and no deductibles. The plan covers one routine eye exam per year and provides a $100 annual combined maximum for contact lenses, eyeglass lenses, and eyeglass frames, while other eye exams, upgrades, and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dental Value (HMO) partially covers dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 20% coinsurance for other covered preventive and comprehensive services up to a $3,000 yearly limit. Covered benefits include oral exams, cleanings, x-rays, restorative care, endodontics, periodontics, prosthodontics, and oral surgery, while other diagnostic services, fluoride treatment, other preventive services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Dental Value (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Dental Value (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Dental Value (HMO) with no copay, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Blue Cross Medicare Advantage Dental Value (HMO) with no coinsurance for diagnostic services, including lab services with no copay and diagnostic tests carrying a $0 to $100 copay. Radiological services require referrals and prior authorization, featuring outpatient X-rays with no copay and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Blue Cross Medicare Advantage Dental Value (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Blue Cross Medicare Advantage Dental Value (HMO) with no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Dental Value (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20 and days 40 through 100, but a $218 copay applies for days 21 through 39, with no coverage provided for additional days beyond the Medicare limit.
Other Services See details
Blue Cross Medicare Advantage Dental Value (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $70 maximum benefit every three months that carries forward. Acupuncture, meal benefits, and Naloxone are not covered under this benefit.
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