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Blue Cross Medicare Advantage Saver (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Saver (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 Saver (HMO) in 2025, please refer to our full plan details page.
Blue Cross Medicare Advantage Saver (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 Saver (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 Saver (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 Saver (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced 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 $7500.00 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 Saver (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. The plan also offers premium reductions if you qualify for the low-income subsidy.
Additional Benefits
The Blue Cross Medicare Advantage Saver (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the specific service. This plan includes coverage for ambulance services, emergency care, and primary care with no copay, and offers additional benefits like hearing, vision, and dental services. Vision includes eye exams and eyewear, with some limitations, and dental includes oral exams, x-rays, and cleaning. This plan also provides coverage for preventive services, including an annual physical exam with no copay. It also covers home health services, and skilled nursing facility (SNF) services. Additionally, the plan covers diagnostic and radiological services, and home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital coverage includes 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 and Non-Medicare-covered Stay 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 $350 copay, Ambulatory Surgical Center Services have a $295 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a $75 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Saver (HMO) plan, requiring prior authorization and a doctor's referral. The copay for this service is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Blue Cross Medicare Advantage Saver (HMO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance; however, 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 Saver (HMO) plan, with copays of $100, $40, and $100, respectively, and no coinsurance. Worldwide Urgent Coverage is also covered with a $100 copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Blue Cross Medicare Advantage Saver (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, with routine care not covered. Occupational Therapy Services and Individual/Group Sessions for Mental Health/Psychiatric Services have a $35 copay. Physician Specialist Services have a $28 copay, while Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth Benefits and Opioid Treatment Program Services are also covered, with no copay for telehealth and a copay between $35 for Opioid Treatment Program Services. Other Health Care Professional services have a copay between $0 and $28.
Preventive Services See details
The Blue Cross Medicare Advantage Saver (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Fitness Benefit and Remote Access Technologies, are covered, with no copay for services. Other services, such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a copay between $699 and $999, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Blue Cross Medicare Advantage Saver (HMO) plan covers vision services, including eye exams and eyewear. Eye exams, routine eye exams, and contact lenses have no copay, while eyeglasses (lenses and frames) and upgrades are not covered. Eyeglasses (lenses and frames) have a combined maximum plan benefit coverage amount of $100 per year.
Dental Services See details
Dental Services include coverage for oral exams and dental x-rays with no copay, prophylaxis (cleaning) with no copay, and a $35 copay for Medicare dental services. Orthodontic Services are covered up to a maximum of $1000 per year, and restorative services are covered with no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Cross Medicare Advantage Saver (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Blue Cross Medicare Advantage Saver (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Blue Cross Medicare Advantage Saver (HMO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and authorization required. Prosthetic devices and medical supplies are covered with a 20% coinsurance, and diabetic supplies are covered with 0-20% coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Radiological Services also have coverage, with Diagnostic Radiological Services having a copay up to $250, Therapeutic Radiological Services having a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Saver (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, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Saver (HMO) plan, but require prior authorization and a doctor referral. For days 1-20 and 60-100, there is no copay, while days 21-59 have a $214 copay, and additional days beyond Medicare-covered stays and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Blue Cross Medicare Advantage Saver (HMO) plan, including acupuncture, over-the-counter items, meal benefits, and more. No authorization or referrals are required for these services.
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