2027 Medicare Advantage plan
Blue Cross Medicare Advantage Basic (HMO-POS): 2027 benefits and costs
Blue Cross and Blue Shield of IL, NM HMO-POS
CMS plan ID: H3822-001-0 · Plan year: 2027
Blue Cross Medicare Advantage Basic (HMO-POS) is a 2027 Medicare Advantage plan offered by Blue Cross and Blue Shield of IL, NM. It is listed in Illinois.
2027 plan costs at a glance
Monthly plan premium$29.00
Drug deductible$500.00
In-network medical out-of-pocket maximum$5,500.00
- Organization
- Blue Cross and Blue Shield of IL, NM
- Plan organization
- HEALTH CARE SERVICE CORPORATION
- Parent company
- Health Care Service Corporation
- Plan type
- HMO-POS
- Part C premium
- $29.00
- Part D premium
- $0.00
- Prescription drug coverage
- Yes
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- In-network medical deductible
- None
- Combined in/out-of-network medical deductible
- None
- Out-of-network medical deductible
- None
- In-network medical maximum
- $5,500.00
- Combined in/out-of-network medical maximum
- Not applicable
- Out-of-network medical maximum
- Not applicable
2027 benefit summary
Doctor visits and medical care
| Service | In-network | What to know |
|---|---|---|
| Primary care doctor | $0
| |
| Specialist visit | $20.00 copay
|
|
| Telehealth | $0
|
|
| Emergency care | $130.00 copay | |
| Urgent care | $50.00 copay | |
| Home health | $0
|
|
| Dialysis | 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
|
|
| Kidney disease education services | $0
|
|
| Medicare-covered chiropractic | $15.00 copay
|
|
| Medicare-covered foot care | $20.00 copay
|
|
| Other health professionals | $0.00 to $20.00 copay
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–7: $250.00 copay per day Days 8–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–7: $250.00 copay per day Days 8–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $10.00 copay per day Days 21–39: $221.00 copay per day Days 40–100: $0.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | What to know |
|---|---|---|
| Outpatient hospital care | $0.00 to $300.00 copay
| |
| Hospital observation services | $300.00 copay
| |
| Ambulatory surgical center | $0.00 to $275.00 copay
|
|
| Outpatient blood | $0
|
|
Tests, imaging and laboratory services
| Service | In-network | What to know |
|---|---|---|
| Diagnostic procedures and tests | $0.00 to $50.00 copay
|
|
| Laboratory services | $0.00 to $50.00 copay
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $250.00 copay
|
|
| Therapeutic radiology | 20% coinsurance
|
|
| X-rays | $0.00 to $100.00 copay
|
|
Mental health and substance use treatment
| Service | In-network | What to know |
|---|---|---|
| Partial hospitalization | $155.00 copay
|
|
| Intensive outpatient program | $160.00 copay
|
|
| Substance use treatment, individual sessions | $20.00 copay
|
|
| Substance use treatment, group sessions | $20.00 copay
|
|
| Opioid treatment program | $20.00 copay
|
|
| Mental health, individual sessions | $30.00 copay
|
|
| Mental health, group sessions | $30.00 copay
|
|
| Psychiatry, individual sessions | $30.00 copay
|
|
| Psychiatry, group sessions | $30.00 copay
|
|
Therapy and rehabilitation
| Service | In-network | What to know |
|---|---|---|
| Occupational therapy | $50.00 copay
|
|
| Physical and speech therapy | $20.00 copay
|
|
| Cardiac rehabilitation | $40.00 copay
|
|
| Intensive cardiac rehabilitation | $55.00 copay
|
|
| Pulmonary rehabilitation | $35.00 copay
|
|
| Supervised exercise for peripheral artery disease | $25.00 copay
|
|
Ambulance, medical equipment and supplies
| Service | In-network | What to know |
|---|---|---|
| Ground ambulance | $250.00 copay
|
|
| Air ambulance | 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
|
|
| Medical supplies | 20% coinsurance
|
|
| Diabetic supplies | 0% to 20% coinsurance
|
|
| Diabetic shoes and inserts | 20% coinsurance
|
|
| Diabetic monitors | 0% to 20% coinsurance
|
|
Dental benefits
| Service | In-network | Point-of-service | What to know |
|---|---|---|---|
| Medicare-covered dental | $20.00 copay | 50% coinsurance
| |
| Oral examsAdditional plan benefit | $0 | 0% to 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0 | 0% to 50% coinsurance
| |
| Other diagnostic dentalAdditional plan benefit | $0 | 0% to 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0 | 0% to 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | 0% to 50% coinsurance | 0% to 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | $0 | 0% to 50% coinsurance
| |
| Dental implantsAdditional plan benefit | $0 | 0% to 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | 50% coinsurance | 0% to 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | 0% to 50% coinsurance | 0% to 50% coinsurance
|
Vision benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered eye exams | $0.00 to $20.00 copay
|
|
| Routine eye examsAdditional plan benefit | $0 |
|
| Medicare-covered eyewear | $0
|
|
| Contact lensesAdditional plan benefit | $0 |
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 |
|
| Eyeglass lensesAdditional plan benefit | $0 |
|
| Eyeglass framesAdditional plan benefit | $0 |
|
Hearing benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered hearing exams | $20.00 copay
|
|
| Routine hearing examsAdditional plan benefit | $0 |
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 |
|
| Prescription hearing aids (all types)Additional plan benefit | $699.00 to $999.00 copay
|
|
Extra benefits
| Service | In-network | What to know |
|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| |
| Annual physical examAdditional plan benefit | $0
|
|
| Fitness benefitAdditional plan benefit | $0
|
|
Allowances and optional benefits
Optional packages that cost extra
Silver Package $38.90 extra per month
Dental Maximum and Comprehensive Dental Step-up
The limits below apply only to this optional package.
- Benefit allowance
- $1,000.00
- How often this limit applies
- Every year
- Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?
- No
- Deductible applies
- No
- Included services
- Oral Exams; Dental X-Rays; Other Diagnostic Dental Services; Dental cleaning; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Implant Services; Fixed dental restorations (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.
Standard retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $1.00 | $2.00 | $3.00 |
| Tier 3Preferred Brand | 25% | 25% | 25% |
| Tier 4Non-Preferred Drug | 25% | 25% | 25% |
| Tier 5Specialty Tier | 28% | Not listed | Not listed |
Mail-order and other pharmacies
Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.
Standard mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $1.00 | $2.00 | $2.00 |
| Tier 3Preferred Brand | 25% | 25% | 25% |
| Tier 4Non-Preferred Drug | 25% | 25% | 25% |
| Tier 5Specialty Tier | 28% | Not listed | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $1.00 |
| Tier 3Preferred Brand | 25% |
| Tier 4Non-Preferred Drug | 25% |
| Tier 5Specialty Tier | 28% |
Out-of-network pharmacy costs
| Drug tier | 30 days |
|---|---|
| Tier 1Preferred Generic | $0.00 |
| Tier 2Generic | $1.00 |
| Tier 3Preferred Brand | 25% |
| Tier 4Non-Preferred Drug | 25% |
| Tier 5Specialty Tier | 28% |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
- Initial-coverage prices also apply to drugs exempt from the deductible
- Yes
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.