True Blue Rx (HMO)

H1350 - 030 - 0
4.5 out of 5 stars (4.5 / 5)

True Blue Rx (HMO) is a Medicare Advantage (Part C) Plan by Blue Cross of Idaho.

This page features plan details for 2024 True Blue Rx (HMO) H1350 – 030 – 0 available in Select Counties in Idaho.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

True Blue Rx (HMO) is offered in the following locations.

Plan Overview

True Blue Rx (HMO) offers the following coverage and cost-sharing.

Insurer:Blue Cross of Idaho
Health Plan Deductible:$0.00
MOOP:$6,200 In-network
Drugs Covered:Yes
Please Note:
  • This plan does not charge an annual deductible for all drugs. The $175.00 annual deductible only applies to drugs on certain tiers.

Ready to sign up for True Blue Rx (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

True Blue Rx (HMO) has a monthly premium of $72.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $41.50 $30.50 $0.00 $246.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

True Blue Rx (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$175.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Enhanced Alternative
Additional Gap Coverage:
Formulary Link: Formulary Link

Part D Premium Reduction

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 DLIS Full
$30.50$

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.

Initial Coverage Phase

After you pay your $175.00 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.

Gap Coverage Phase

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%

Catastrophic Coverage Phase

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.

Additional Benefits

True Blue Rx (HMO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,200 In-network

Optional supplemental benefits

Yes

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

$0-325 copay per visit (Authorization is required.) (Referral is not required.)

Doctor visits

Primary$10 copay per visit (Not applicable.) (Not applicable.)
Specialist$40 copay per visit (Authorization is not required.) (Referral is not required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$40 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$30 copay or 20% coinsurance (Authorization is not required.) (Referral is not required.)
Lab services$5 copay (Authorization is not required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)$0-250 copay (Authorization is required.) (Referral is not required.)
Outpatient x-rays$15 copay (Authorization is required.) (Referral is not required.)

Hearing

Hearing exam$40 copay (Authorization is not required.) (Referral is not required.)
Fitting/evaluation$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
Hearing aids$499-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

Office visit$20.00 (Authorization is not required.) (Referral is not required.)
Oral examCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
CleaningCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatmentCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

Routine eye exam$20 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lenses$0-35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglasses (frames and lenses)$35 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Upgrades$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Rehabilitation services

Occupational therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
Physical therapy and speech and language therapy visit$40 copay (Authorization is not required.) (Referral is not required.)

Ground ambulance

$270 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

Foot exams and treatment$40 copay (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is required.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
Diabetes supplies$0 copay per item (Authorization is not required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$295 per day for days 1 through 6
$0 per day for days 7 through 90 (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$290 per day for days 1 through 6
$0 per day for days 7 through 90 (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
Outpatient group therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit$40 copay (Authorization is not required.) (Referral is not required.)

Skilled Nursing Facility

$0 per day for days 1 through 20
$203 per day for days 21 through 55
$0 per day for days 56 through 100 (Authorization is required.) (Referral is not required.)

Package #1

Monthly Premium$23.70
Deductible$50.00

Optional Benefits

Package #1

Comprehensive dental:Monthly Premium:$19.80
Comprehensive dental:Deductible:$50.00

Ready to sign up for True Blue Rx (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

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