2027 Medicare Advantage plan

BlueMedicare Classic (HMO): 2027 benefits and costs

Florida Blue HMO HMO

CMS plan ID: H1035-019-0 · Plan year: 2027

BlueMedicare Classic (HMO) is a 2027 Medicare Advantage plan offered by Florida Blue HMO. It is listed in Florida.

2027 plan costs at a glance

Monthly plan premium$0.00
Drug deductible$700.00
In-network medical out-of-pocket maximum$6,750.00
Organization
Florida Blue HMO
Plan organization
FLORIDA BLUE MEDICARE, INC.
Parent company
Guidewell Mutual Holding Corporation
Plan type
HMO
Part C premium
$0.00
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
In-network medical maximum
$6,750.00

Applies to certain in-network supplemental services.

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No
Specialist visit

$40.00 to $55.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Telehealth

$0.00 to $60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Emergency care

$130.00 copay

Urgent care

$50.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered foot care

$30.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Other health professionals

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–7: $345.00 copay per day

Days 8–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–7: $295.00 copay per day

Days 8–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $0.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $250.00 copay

Service-specific deductible
No
Hospital observation services

$130.00 copay

Service-specific deductible
No
Ambulatory surgical center

$0.00 to $200.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 to $100.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Laboratory services

$0.00 to $50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Diagnostic radiology (CT, MRI)

$0.00 to $250.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
X-rays

$0.00 to $100.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Opioid treatment program

$40.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, individual sessions

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Physical and speech therapy

$13.00 to $50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Cardiac rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Intensive cardiac rehabilitation

$50.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Pulmonary rehabilitation

$15.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes
Supervised exercise for peripheral artery disease

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$0.00 to $310.00 copay

Service-specific deductible
No
Approval required
Yes
Air ambulance

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

0% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
No
Diabetic shoes and inserts

$0.00 copay

Service-specific deductible
No
Approval required
No
Diabetic monitors

0% to 20% coinsurance

Service-specific deductible
No
Approval required
No

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$55.00 copay

Oral examsAdditional plan benefit

Confirm with the plan (copay)

Dental X-raysAdditional plan benefit

Confirm with the plan (copay)

Dental cleaningAdditional plan benefit

Confirm with the plan (copay)

Removable dentures (prosthodontics)Additional plan benefit

$0.00 copay

Oral surgeryAdditional plan benefit

$0.00 copay

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $55.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
Yes
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$55.00 copay

Service-specific deductible
No
Approval required
No
Referral required
Yes
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
Yes
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
Yes
Prescription hearing aids (all types)Additional plan benefit

$350.00 to $1,825.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2; Tier 6 are exempt from the deductible.

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier31 days90 days100 days
Tier 1Preferred Generic

$0.00

Not listed

$0.00

Tier 2Generic

$0.00

Not listed

$0.00

Tier 3Preferred Brand

19%

19%

Not listed
Tier 4Non-Preferred Drug

26%

26%

Not listed
Tier 5Specialty Tier

25%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

Not listed

$0.00

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.

Standard mail order: initial-coverage cost per prescription fill
Drug tier31 days90 days100 days
Tier 1Preferred Generic

$0.00

Not listed

$0.00

Tier 2Generic

$0.00

Not listed

$0.00

Tier 3Preferred Brand

19%

19%

Not listed
Tier 4Non-Preferred Drug

26%

26%

Not listed
Tier 5Specialty Tier

25%

Not listedNot listed
Tier 6Select Care Drugs

$0.00

Not listed

$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$0.00

Tier 3Preferred Brand

19%

Tier 4Non-Preferred Drug

26%

Tier 5Specialty Tier

25%

Tier 6Select Care Drugs

$0.00

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$0.00

Tier 2Generic

$0.00

Tier 3Preferred Brand

19%

Tier 4Non-Preferred Drug

26%

Tier 5Specialty Tier

25%

Tier 6Select Care Drugs

$0.00

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

Tier 6: Select Care Drugs

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
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.

View all locations 21 county listings across 1 state or territory

Florida