Get Covered
Blue Medicare Medical Only (HMO-POS)
H3449 - 012 - 0
(4.5 / 5)
Blue Medicare Medical Only (HMO-POS) is a Medicare Advantage (Part C) Plan by Blue Cross and Blue Shield of North Carolina.
This page features plan details for 2023 Blue Medicare Medical Only (HMO-POS) H3449 – 012 – 0 available in Select North Carolina Counties.
IMPORTANT: This page has been updated with plan and premium data for 2023.
Locations
Blue Medicare Medical Only (HMO-POS) is offered in the following locations.
Plan Overview
Blue Medicare Medical Only (HMO-POS) offers the following coverage and cost-sharing.
| Insurer: | Blue Cross and Blue Shield of North Carolina |
| Health Plan Deductible: | $0.00 |
| MOOP: | $3,900 In-network |
| Drugs Covered: | No |
Ready to sign up for Blue Medicare Medical Only (HMO-POS) ?
Get help from a licensed Medicare agent.
Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Blue Medicare Medical Only (HMO-POS) qualifies for a monthly Medicare Give Back Benefit of $50.00.
| Premium Reduction: | $50.00 |
Premium Breakdown
Blue Medicare Medical Only (HMO-POS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $164.90 | $0.00 | $50.00 | $114.90 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Blue Medicare Medical Only (HMO-POS) also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | Not covered (no limits) |
| Endodontics: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
| Endodontics: | Out-of-Network: 20% coinsurance (limits may apply) (authorization required) (referral not required) |
| Extractions: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
| Extractions: | Out-of-Network: 20% coinsurance (limits may apply) (authorization required) (referral not required) |
| Non-routine services: | Not covered (no limits) |
| Periodontics: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
| Periodontics: | Out-of-Network: 20% coinsurance (limits may apply) (authorization required) (referral not required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: 20% coinsurance (limits may apply) (authorization required) (referral not required) |
| Restorative services: | In-Network: $0 copay (limits may apply) (authorization required) (referral not required) |
| Restorative services: | Out-of-Network: 20% coinsurance (limits may apply) (authorization required) (referral not required) |
Dental (preventive)
| Cleaning: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Cleaning: | Out-of-Network: 20% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Dental x-ray(s): | Out-of-Network: 20% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Fluoride treatment: | Out-of-Network: 20% coinsurance (limits may apply) (authorization not required) (referral not required) |
| Oral exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Oral exam: | Out-of-Network: 20% coinsurance (limits may apply) (authorization not required) (referral not required) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | In-Network: $0-300 copay or 20% coinsurance (authorization required) (referral not required) |
| Diagnostic tests and procedures: | In-Network: $0-25 copay (authorization not required) (referral not required) |
| Lab services: | In-Network: $0-5 copay (authorization not required) (referral not required) |
| Outpatient x-rays: | In-Network: $0-15 copay (authorization required) (referral not required) |
Doctor visits
| Primary: | In-Network: $0 copay |
| Specialist: | In-Network: $25 copay per visit (authorization not required) (referral not required) |
Emergency care/Urgent care
| Emergency: | $110 copay per visit (always covered) |
| Urgent care: | $60 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | In-Network: $25 copay (authorization not required) (referral not required) |
| Routine foot care: | Not covered |
Ground ambulance
| In-Network: $250 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | In-Network: $0 copay (no limits) (authorization not required) (referral not required) |
| Hearing aids: | In-Network: $699-999 copay (limits may apply) (authorization not required) (referral not required) |
| Hearing exam: | In-Network: $25 copay (authorization not required) (referral not required) |
Hospital coverage (inpatient)
| In-Network: $295 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond (authorization required) (referral not required) | |
| Out-of-Network: Not Applicable (authorization required) (referral not required) |
Hospital coverage (outpatient)
| In-Network: $275 copay per visit (authorization required) (referral not required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $3,900 In-network |
Medical equipment/supplies
| Diabetes supplies: | In-Network: 0-20% coinsurance per item (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
| Other Part B drugs: | In-Network: 20% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | In-Network: $295 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
| Inpatient hospital – psychiatric: | Out-of-Network: Not Applicable (authorization required) (referral not required) |
| Outpatient group therapy visit: | In-Network: $25 copay (authorization required) (referral not required) |
| Outpatient group therapy visit with a psychiatrist: | In-Network: $25 copay (authorization required) (referral not required) |
| Outpatient individual therapy visit: | In-Network: $25 copay (authorization required) (referral not required) |
| Outpatient individual therapy visit with a psychiatrist: | In-Network: $25 copay (authorization required) (referral not required) |
Optional supplemental benefits
| No |
Preventive care
| In-Network: $0 copay (authorization not required) (referral not required) |
Rehabilitation services
| Occupational therapy visit: | In-Network: $40 copay (authorization not required) (referral not required) |
| Physical therapy and speech and language therapy visit: | In-Network: $25 copay (authorization not required) (referral not required) |
Skilled Nursing Facility
| In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 60 $0 per day for days 61 through 100 (authorization required) (referral not required) | |
| Out-of-Network: Not Applicable (authorization required) (referral not required) |
Transportation
| In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Vision
| Contact lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass frames: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglass lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Eyeglasses (frames and lenses): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
| Other: | In-Network: $25 copay (limits may apply) (authorization not required) (referral not required) |
| Routine eye exam: | In-Network: $25 copay (limits may apply) (authorization not required) (referral not required) |
| Upgrades: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Wellness programs (e.g., fitness, nursing hotline)
| Covered (authorization not required) (referral not required) |
Ready to sign up for Blue Medicare Medical Only (HMO-POS) ?
Get help from a licensed Medicare agent.
Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.