BlueMedicare Independence (HMO)

Medical Deductible

$0.00

Doctor Office Visits

$0 copay

Specialist Office Visit

$30 copay

Telehealth

$0 copay for urgently needed services, primary care provider services, specialist services, and outpatient mental health (mental health specialty and psychiatry - individual and group sessions).

Inpatient Hospital Care

$390 copay per day fordays 1-5.

$0 copay per day for days6-90.

Comprehensive dental benefits

$3,000 per year for comprehensive (and preventive) dental services. Please see plan documents for more details.

Comprehensive hearing benefits

$0 copay for 1 routinehearing exam per year.

$1,000 allowance perhearing aid (one per year).

Please see plan documents for more details.

Comprehensive vision benefits

$0 copay for 1 routine eyeexam per year.

$250 per year for routine eyewear (contacts, eyeglasses, and upgrades.

Please see plan documents for more details.

Nations Benefits Card (Over-the-Counter Items)

$105 per quarter, no rollover

Transportation

$0 copay per trip for 60 one-way trips per year to plan-approved health related locations.

24/7 Nurse Hotline

Access to the Nurse24 nurse advice line 24 hours a day, seven days a week, 365 days a year. Registered nurses can provide information on home treatment of minor illnesses and injuries, how to prepare for doctor visits, how to understand your prescription drugs, and much more.

SilverSneakers® fitness program

Access to a fitness benefit virtually and at participating SilverSneakers facilities, giving you access to instructor-led group exercise classes, exercise equipment, and options to get active outside of traditional gyms, as well as virtual options.

In-Network Maximum Out-of-Pocket

$6,200

Out-of-Network Coverage

Out-of-network services are not covered, except for emergency and urgently needed care. You must use network providers for plan services, except in emergency situations.

Prescription deductible

$615 on Tier 2, Tier 3, Tier 4, and Tier 5

Out-of-Pocket

$2,100

One-Month Supply (Retail Pharmacy) with Standard Cost Sharing

Preferred Generic

$4 copay

Generic

$14 copay

Preferred Brand

20% coinsurance

Non-Preferred Drug

34% coinsurance

Specialty Tier

25% coinsurance

Insulin Products

Lesser of a $35 copay or 20% coinsurance on Tier 3 and the lesser of a $35 copay or 25% coinsurance on Tier 4 and Tier 5 for a one-month supply

100-Day Supply (Retail Pharmacy) with Standard Cost Sharing

Preferred Generic

$12 copay

Generic

$42 copay

Preferred Brand

20% coinsurance

Non-Preferred Drug

34% coinsurance

Specialty Tier

Not covered

Insulin Products

Lesser of a $70 copay or 20% coinsurance on Tier 3 and the lesser of a $70 copay or 25% coinsurance on Tier 4 for a two-month supply

Lesser of a $105 copay or 20% coinsurance on Tier 3 and the lesser of a $105 copay or 25% coinsurance on Tier 4 for a three-month supply

Summary of Benefits

BlueMedicare Independence (HMO) 2026 Summary of Benefits

Plan Documents

BlueMedicare Independence (HMO) Plan Documents