Medicare HMO Blue PlusRx (HMO)
Medicare HMO Blue PlusRx (HMO) is a managed-care Medicare Advantage plan 
. Medicare HMO Blue PlusRx covers 100 percent of your Original Medicare benefits (Parts A and B) and often adds Part D prescription coverage, creating a comprehensive plan that offers additional benefits beyond Original Medicare. With Medicare HMO Blue PlusRx (HMO) you get the routine care you need from a primary care physician (PCP) participating in our Medicare HMO Blue plans network. Your PCP will also coordinate your care with the specialists, hospitals, and other providers that are part of the network.
Benefit Overview
| Medicare HMO Blue PlusRx | |
| Monthly Plan Premium | $179.00* |
| Plan Information | |
| Medical | |
| Doctor Office Visits | $15 |
| Specialist Office Visits | $25 |
| Annual Medical Out-of-Pocket Maximum | $3,400 |
| Inpatient Hospital Care | Days 1-5: $100 copay per day $500 annual maximum |
| Outpatient Services / Surgery | $0 to $100 copay |
| Diagnostic Procedures, Test and Lab Services | 10% lab and certain high-tech imaging, $0 for x-rays and other diagnostic tests |
| Emergency Care | $0 - $50 copay |
| Other Preventive Services | |
| Annual Routine Vision Exam | $25 copay for 1 routine test per year |
| Annual Eyeglasses Benefit | $150 limit for eyewear every two years |
| Annual Routine Hearing Exam | $15 - $25 copay for 1 routine test per year |
| Hearing Aid Allowance | Up to $400 limit every 3 years |
| Annual Fitness Benefit | $150 toward fitness club membership per year |
| Drug Tiers: (30-day retail / 90-day mail order) | |
| Tier 1: Generic | 25% / 25% |
| Tier 2: Preferred Brand | 25% / 25% |
| Tier 3: Non-Preferred Brand | 25% / 25% |
| Tier 4: Speciality Drugs | 25% / 25% |
| Rx Deductibles | $310 |
* Your monthly premium will be different if you qualify for Extra Help from Medicare.
As a Medicare HMO Blue PlusRx (HMO) plan member, you'll also get additional benefits beyond Original Medicare, such as:
- Routine annual physicals
- Coverage for routine hearing exams and vision care
- Allowances toward hearing aids and eyewear
- Routine preventive dental care
- Prevention and wellness programs
- Worldwide coverage for emergency care
Medicare HMO Blue PlusRx (HMO) also offers Medicare Part D prescription coverage. This makes it easy for you to get your medical and prescription benefits from one plan. See Medicare Advantage Prescription Coverage for more information.
- Summary of Benefits and Evidence of Coverage for 2010
- Eligibility
- Access to Care
- Is your doctor part of the network?
- Looking for a new physician?
- About Our Contract
- How to Enroll
Summary of Benefits and Evidence of Coverage for 2010
- Medicare HMO Blue PlusRx (HMO) Summary of Benefits
- Medicare HMO Blue PlusRx (HMO) Evidence of Coverage
Eligibility
Anyone who meets the following criteria is eligible for membership:
- You must be entitled to Medicare Part A and enrolled in Part B.
- You must permanently reside in the Medicare HMO Blue PlusRx (HMO) service area, which includes Bristol, Barnstable, Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, and Worcester counties in Massachusetts.
- You must not currently have end-stage renal disease (ESRD). If you initiated dialysis treatments for ESRD, but have recovered your normal kidney function and no longer require a regular course of dialysis to maintain life, or have had a successful kidney transplant, or are currently a member of Blue Cross Blue Shield of Massachusetts, you may still join the plan. In addition, if you were a member of a Medicare Advantage plan that terminated its services after December 31, 1998, and you currently have end-stage renal disease, you may still join the plan.
Access to Care
If you're a member of Medicare HMO Blue PlusRx (HMO), you'll choose a primary care physician (PCP) from our Medicare HMO Blue network. Your PCP will coordinate your care and refer you to any in-network specialists you may need.
If you choose to go to a doctor outside of our network, you may have to pay the full cost for these services yourself. However, Blue Cross Blue Shield of Massachusetts or Original Medicare coverage will pay for the following out-of-network services when appropriate:
- Emergency services
- Urgent care
- Out-of-area dialysis
For more information please refer to the plan Evidence of Coverage (EOC) agreement.
Is your doctor part of the network?
If you already have a primary care physician, and want to learn whether he or she is already a part of our network, just call 1-800-200-4255 (TTY: 1-800-522-1254), Monday through Friday, 8:00 a.m. to 8:00 p.m. ET, or visit Find a Doctor.
Looking for a new physician?
You can choose a physician from our list of participating providers. Our network of physicians is subject to change, but you can keep up-to-date with the most complete list of current network physicians by:
- using our Find a Doctor feature at www.bluecrossma.com or
- calling Member Service at 1-800-200-4255 (TTY: 1-800-522-1254) Monday through Friday, 8:00 a.m. to 8:00 p.m. ET to request a copy of the directory.
About Our Contract
Blue Cross Blue Shield of Massachusetts is a Medicare Advantage organization with a Medicare contract. Such contracts are valid for one year. Therefore, the benefits, premiums , copayments , and service areas offered by Medicare HMO Blue PlusRx (HMO) may change on an annual basis.
How to Enroll
If you're interested in enrolling in Medicare HMO Blue PlusRx (HMO), just visit the Enrollment section for a list of important dates, applications, and instructions.
