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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 2025, 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 Texas. This plan received an overall rating of 3 out of 5 stars in 2025.
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 $590.00 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 $4850.00 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 has a $590 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance for your medications, depending on the drug tier and pharmacy type. For example, in the initial coverage phase, you can expect to pay a $10 or $20 copay for preferred and standard generic drugs, and 25% coinsurance for preferred brand and non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Dental Value (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay depending on the type of service and length of stay. Outpatient services, emergency services, and ambulance services are also covered with copays or coinsurance. This plan includes no copay for primary care visits, preventive services, eye exams, oral exams, and home health services. Dental, hearing, and vision services, including eye exams and eyewear, are included. Additionally, the plan covers home infusion services, dialysis, medical equipment, diagnostic services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $370 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a $325 copay, while Ambulatory Surgical Center Services have a $295 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan with a $55 copay, and prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Coverage has a $125 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Dental Value (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $29 copay, mental health and psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $35 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services including Fitness Benefit and Remote Access Technologies, with no copay. Other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered with no copay, limited to 1 visit every year. Prescription hearing aids are partially covered, with a copay between $699 and $999 for prescription hearing aids of all types; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams and contact lenses have no copay, while eyeglass lenses and frames have no copay, with a combined maximum of $100 per year for eyewear. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Dental Value (HMO) plan covers dental services, including oral exams with no copay for two visits per year, dental x-rays with no copay for one per year, and prophylaxis (cleaning) with no copay for two visits per year. This plan does not cover fluoride treatment, implant services, or orthodontics. Other services, such as endodontics, prosthodontics, and maxillofacial prosthetics, are covered with 20% coinsurance, while restorative services and adjunctive general services have no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For the other drugs, the coinsurance also ranges from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a 20% coinsurance for Medicare-covered devices and supplies, and Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Dental 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 not covered by the Blue Cross Medicare Advantage Dental Value (HMO) plan. Prior authorization and a doctor's referral are required for this benefit, but the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by this plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20 and 40-100, but will have a $214 copay for days 21-39.
Other Services See details
Other Services includes coverage for over-the-counter items with no copay, and a maximum plan benefit coverage amount of $50 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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