Medicare HMO Blue FlexRx (HMO-POS) is a Medicare Advantage (Part C) Plan by Blue Cross Blue Shield of Massachusetts.
This page features plan details for 2024 Medicare HMO Blue FlexRx (HMO-POS) H2261 – 023 – 1 available in Massachusetts except BER, DUK, NAN, WOR.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Medicare HMO Blue FlexRx (HMO-POS) is offered in the following locations.
Medicare HMO Blue FlexRx (HMO-POS) offers the following coverage and cost-sharing.
Insurer: | Blue Cross Blue Shield of Massachusetts |
Health Plan Deductible: | $0.00 |
MOOP: | $3,400 In-network $5,750 Out-of-network |
Drugs Covered: | Yes |
Ready to sign up for Medicare HMO Blue FlexRx (HMO-POS) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $58.00 | $20.00 | $0.00 | $252.70 |
Medicare HMO Blue FlexRx (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $260.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$20.00 | $ |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $260.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $6.00 copay | $0.00 copay | $5.00 copay |
2 (Generic) | $5.00 copay | $10.00 copay | $5.00 copay | $10.00 copay |
3 (Preferred Brand) | $42.00 copay | $47.00 copay | $42.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay | $95.00 copay | $100.00 copay |
5 (Specialty Tier) | 28% | 28% | 28% | 28% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $18.00 copay | $0.00 copay | $5.00 copay |
2 (Generic) | $15.00 copay | $30.00 copay | $10.00 copay | $15.00 copay |
3 (Preferred Brand) | $126.00 copay | $141.00 copay | $84.00 copay | $89.00 copay |
4 (Non-Preferred Drug) | $285.00 copay | $300.00 copay | $190.00 copay | $195.00 copay |
5 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Medicare HMO Blue FlexRx (HMO-POS) also provides the following benefits.
$0 |
In-network | No |
$3,400 In-network $5,750 Out-of-network |
No |
In-network | No |
In-network | $160 copay per visit (Authorization is required.) (Referral is not required.) |
out-of-network | 20% coinsurance per visit (Authorization is required.) (Referral is not required.) |
In-network Primary | $10 copay per visit (Not applicable.) (Not applicable.) |
out-of-network Primary | $65 copay per visit (Not applicable.) (Not applicable.) |
In-network Specialist | $0-35 copay per visit (Authorization is required.) (Referral is required.) |
out-of-network Specialist | $65 copay per visit (Authorization is required.) (Referral is required.) |
In-network | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network | $65 copay or 20% coinsurance (Authorization is required.) (Referral is not required.) |
Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $0-60 copay per visit (always covered) (Not applicable.) (Not applicable.) |
In-network Diagnostic tests and procedures | $0-10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic tests and procedures | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Lab services | $0-10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Lab services | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Diagnostic radiology services (e.g., MRI) | $200 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic radiology services (e.g., MRI) | 40% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient x-rays | $10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient x-rays | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Hearing exam | $10-35 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Hearing exam | $65 copay (Authorization is not required.) (Referral is not required.) |
In-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Oral exam | $45 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Cleaning | $45 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Dental x-ray(s) | $45 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
In-network Occupational therapy visit | $15 copay (Authorization is required.) (Referral is not required.) |
out-of-network Occupational therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Physical therapy and speech and language therapy visit | $15 copay (Authorization is required.) (Referral is required.) |
out-of-network Physical therapy and speech and language therapy visit | 20% coinsurance (Authorization is required.) (Referral is required.) |
In-network | $100 copay (Not applicable.) (Not applicable.) |
out-of-network | $100 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
In-network Foot exams and treatment | $10-35 copay (Authorization is not required.) (Referral is required.) |
out-of-network Foot exams and treatment | $65 copay (Authorization is not required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 10% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Prosthetics (e.g., braces, artificial limbs) | 10% coinsurance per item (Authorization is not required.) (Not applicable.) |
out-of-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
In-network Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
out-of-network Diabetes supplies | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Chemotherapy | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Other Part B drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
out-of-network Part B Insulin drugs | 20% coinsurance (Authorization is required.) (Not applicable.) |
In-network | $245 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is not required.) |
out-of-network | 20% per stay (Authorization is required.) (Referral is not required.) |
In-network Inpatient hospital – psychiatric | $200 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is not required.) |
out-of-network Inpatient hospital – psychiatric | 20% per stay (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit with a psychiatrist | $10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit with a psychiatrist | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit with a psychiatrist | $10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit with a psychiatrist | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit | $10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network Outpatient individual therapy visit | $0-10 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit | 20% coinsurance (Authorization is required.) (Referral is not required.) |
In-network | $0 per day for days 1 through 20 $140 per day for days 21 through 44 $0 per day for days 45 through 100 (Authorization is required.) (Referral is not required.) |
out-of-network | 20% per stay (Authorization is required.) (Referral is not required.) |
Ready to sign up for Medicare HMO Blue FlexRx (HMO-POS) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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