2027 Medicare Advantage plan

BlueMedicare Focus (HMO C-SNP): 2027 benefits and costs

Florida Blue HMO HMO C-SNP Special Needs Plan

CMS plan ID: H1035-056-0 · Plan year: 2027

BlueMedicare Focus (HMO C-SNP) 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$3,400.00

Organization: Florida Blue HMO
Plan organization: FLORIDA BLUE MEDICARE, INC.
Parent company: Guidewell Mutual Holding Corporation
Plan type: HMO C-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Chronic or Disabling Condition
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)
Monthly Part B premium after plan reduction: $79.50 (estimated)$209.50 standard premium less $130.00 plan reduction.

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $3,400.00
Applies to certain in-network supplemental services.

Part B premium reduction: $130.00

Who can join this Special Needs Plan?

This plan is for people with qualifying chronic or disabling conditions. The plan must confirm that your condition meets its eligibility rules.

Plan eligibility type: Chronic or Disabling Condition
Qualifying conditions: Diabetes Mellitus, Chronic Heart Failure, and Cardiovascular Disorders

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	$15.00 copay Service-specific deductible No	Approval required No Referral required Yes
Telehealth	$0.00 to $65.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Emergency care	$150.00 copay
Urgent care	$65.00 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	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$25.00 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.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–7: $145.00 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: $250.00 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
Service	In-network	What to know
Outpatient hospital care	$140.00 copay Service-specific deductible No
Hospital observation services	$150.00 copay Service-specific deductible No
Ambulatory surgical center	$115.00 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
Service	In-network	What to know
Diagnostic procedures and tests	$0.00 to $50.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Laboratory services	$0.00 to $35.00 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
Service	In-network	What 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	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	$30.00 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	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Mental health, group sessions	$30.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, individual sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	$30.00 copay Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$40.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$0.00 to $40.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$35.00 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	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$20.00 copay Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$0.00 to $330.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	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
Service	In-network	What to know
Medicare-covered dental	$15.00 copay
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Other preventive dentalAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Removable dentures (prosthodontics)Additional plan benefit	$0
Fixed dental restorations (prosthodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0
Other dental servicesAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 to $15.00 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
Service	In-network	What to know
Medicare-covered hearing exams	$15.00 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
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Healthy Options Allowance

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Transportation to health-related locations; Over-the-counter health items; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s): Food and produce (SSBCI: Package 1)
How benefits are provided: Catalogue Purchase; Debit Card; Reimbursement
Advance choice of benefits required: No
Shared benefit limit: $105.00
How often this limit applies: Every one month
Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: Yes
Shared limit on visits or trips: No

Benefits for qualifying members

Package 1

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Cardiovascular disorders; Chronic heart failure; Diabetes mellitus
Included services: Food and produce
Some package benefits are exempt from the deductible: Yes
Services exempt from the deductible: Food and produce
Package limit: $0.00
How often this limit applies: Every month
How benefits are provided: Debit Card; Reimbursement
Services sharing the package limit: Food and produce

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2; Tier 3; 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 tier	31 days	90 days	100 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 listed	Not 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 tier	31 days	90 days	100 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 listed	Not 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 tier	31 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 tier	31 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.