Medicare HMO Blue PlusRx | 2023 Medicare Options

Understand Plan Features

Doctors Network Prescriptions Eligibility Discount & Programs

Plan Information

Medical	Cost
Doctor Visits	$0 copay per office or telehealth visit
Specialist Visits	$30 copay per office or telehealth visit
Medicare Preventive Services	$0 copay per visit
Annual Medical Out-of-Pocket Maximum	$3,400 for Medicare-covered services
	Days 1-5: $125 copay per day
	$150 copay per visit
Diagnostic Procedures, Tests, and Lab Services	$0 copay per day for labs, and other diagnostic tests; $5 copay per day for x-rays; $150 copay per day per category of test for certain high-tech imaging, $0 copay for therapeutic radiological services
Emergency Care	$75 copay per visit

- -

Enroll Online

See all Enrollment Options

Other Preventive Services	Cost
Preventive Dental	$0 copay per visit, twice each calendar year
Annual Routine Vision Exam	$0 copay for one routine exam every 12 months with an EyeMed provider
Eyeglasses Benefit	$200 limit for routine eyewear every 24 months from an EyeMed provider
Annual Physical Exam	$0 copay
Annual Routine Hearing Exam	$0 copay for one routine exam every 12 months with a TruHearing provider
Hearing Aid Benefit	$699 copay or $999 copay per hearing aid (one per ear per year) from a TruHearing provider
Annual Fitness Benefit	Up to $250 toward fitness club membership, exercise class fees, online class fees, fitness equipment, and pool-only facilities
Weight Loss Benefit	Up to $150 toward fees paid for qualified weight loss programs per year

To confirm your eligibility and schedule a routine vision or hearing appointment please contact:

EyeMed: 1-866-490-7291 (TTY: 711)

October 1 through March 31: 8:00 a.m. - 11:00 p.m. ET., 7 days a week
April 1 through September 30: 8:00 a.m. - 11:00 p.m. ET., Monday through Saturday;
11:00 a.m. - 8:00 p.m, Sunday.

TruHearing: 1-844-811-3762 (TTY: 711)

8:00 a.m. - 9:00 p.m. ET, Monday through Friday.

Prescription Drug Coverage

Prescription Drug	Cost
Tiers 1 and 2	$0
Tiers 3, 4, and 5	$200

	Amount for 30-day supply	Amount for 30-day supply	CVS Caremark Mail Service Amount for 90-day supply
Tier 1: Preferred Generic	$0 copay	$6 copay	$0 copay
Tier 2: Generic	$5 copay	$10 copay	$10 copay
Tier 3: Preferred Brand	$42 copay	$47 copay	$84 copay
Tier 4: Non-Preferred Drug	$95 copay	$100 copay	$190 copay
Tier 5: Specialty Drugs	29% of the cost	29% of the cost	Not available at 90-day supply
	After your total yearly drug costs reach $4,660, you receive limited coverage by the plan on certain drugs. For covered generics, you pay 25% of the plan's costs. For covered brand drugs, you pay no more than 25% of the plan's costs (excluding dispensing fees).
	After your yearly out-of-pocket drug costs reach $7,400 you pay the greater of: $4.15 copay for generics or drugs treated like generic drugs and a $10.35 copay for all other drugs; or 5% of the cost

CVS Caremark, an independent company that administers your pharmacy benefits on behalf of Blue Cross Blue Shield of Massachusetts.

Additional Benefits

As a Medicare HMO Blue PlusRx plan member, you get additional benefits beyond Original Medicare, such as:

Coverage for routine hearing exams and vision care
Allowances toward hearing aids and eyewear
Routine preventive dental care
Prevention and wellness programs
NEW for 2023 - Learn to Live Online Cognitive Behavioral Therapy
Worldwide coverage for emergency care

Summary of Benefits and Evidence of Coverage

2023 Medicare HMO Blue PlusRx (HMO) Summary of Benefits (Updated 10/01/2022)
2023 Medicare HMO Blue PlusRx (HMO) Evidence of Coverage (Updated 10/01/2022)

Compare 2023 Medicare Plans

No Plans Found

We could not find Medicare plans available in your area. Please make sure the Massachusetts ZIP code you entered is correct.

Other Medicare Plans