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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 2026, 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 San Antonio/Surrounding El Paso 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 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 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 $4750.00 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 Value (HMO)
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Drug Coverage
The Blue Cross Medicare Advantage Value (HMO) plan features a $450 drug deductible and offers excellent savings on generic medications. For Tier 1 preferred generics, you pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generics are also highly affordable, costing just a $1 copay at preferred pharmacies or preferred mail order compared to $6 at standard locations. For higher-tier medications, costs transition to coinsurance percentages during the initial coverage phase. Tier 3 preferred brands require an 18% coinsurance at preferred locations and 22% at standard locations, while Tier 4 non-preferred drugs carry a 37% or 39% coinsurance depending on your choice of pharmacy. Tier 5 specialty drugs have a flat 27% coinsurance across all pharmacy options for a one-month supply.
Additional Benefits
The Blue Cross Medicare Advantage Value (HMO) plan offers comprehensive coverage for core medical needs, featuring no copay and no coinsurance for primary care, telehealth, and preventive services. Specialist visits require a $23 copay, while emergency services are covered with a $125 copay that is waived if you are admitted to the hospital. For hospital stays, inpatient care carries a daily copay with no coinsurance, and outpatient hospital services range from no copay up to a $250 copay. This plan also includes valuable supplemental benefits, providing home health care and routine vision, dental, and hearing exams with no copay and no coinsurance. Members receive a $50 quarterly allowance with no copay for over-the-counter items, and there is no copay for the first 20 days of skilled nursing facility stays. While many services feature no copay, certain specialized care like dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Blue Cross Medicare Advantage Value (HMO) covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 to 6 of acute stays and a $150 daily copay for days 1 to 5 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Value (HMO) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $250 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 Value (HMO) with a $35.00 copay and no coinsurance. Prior authorization and a referral are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance services under the Blue Cross Medicare Advantage Value (HMO) require prior authorization and cost a $275 copay with no coinsurance for ground transport, or a 20% coinsurance with no copay for air transport. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Blue Cross Medicare Advantage Value (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $125 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Blue Cross Medicare Advantage Value (HMO) features no copay and no coinsurance for primary care and telehealth services, while specialist visits require a $23 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies have a $35 copay with no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Blue Cross Medicare Advantage Value (HMO) covers preventive services, including annual physical exams, kidney disease education, fitness benefits, and select screenings, with no copay and no coinsurance. Additional preventive services are only partially covered, as sub-services such as health education, in-home safety assessments, and nutritional/dietary benefits are not covered.
Hearing Services See details
Blue Cross Medicare Advantage Value (HMO) covers hearing services, offering Medicare-covered exams for a $35 copay and no coinsurance, alongside routine annual exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Value (HMO) with no copay, no coinsurance, and no deductible for routine eye exams and eyewear, which features a $100 annual maximum for contacts, lenses, and frames. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered by Blue Cross Medicare Advantage Value (HMO), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive, restorative, and periodontic care. While oral surgery and adjunctive services require no copay and 50% coinsurance, fluoride treatments, implants, orthodontics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Value (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is available for a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Value (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
Blue Cross Medicare Advantage Value (HMO) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Value (HMO) covers diagnostic services with no coinsurance, offering no copay for lab tests and a $0 to $100 copay for diagnostic procedures. Covered radiological services require prior authorization and referrals, featuring no copay for outpatient X-rays, a minimum $0 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Blue Cross Medicare Advantage Value (HMO) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these covered services.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Value (HMO) notes that some services are covered for cardiac rehabilitation with no coinsurance, but prior authorization and a referral are required. Standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $20 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Value (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and days 40 to 100, and a $218 daily copay for days 21 to 39. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Value (HMO) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $50 limit every three months, with unused balances carrying forward. Acupuncture, meal benefits, and naloxone are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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