Blue Medicare Medical Only (HMO-POS) H3449-012 is a 2023 Medicare Advantage Plan or Part-C by Blue Cross and Blue Shield of North Carolina available to residents in North Carolina. This plan does not provide extra prescription drug (Part-D) coverage. Blue Cross and Blue Shield of North Carolina Blue Medicare Medical Only (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,900 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,900 out-of-pocket. This can be an extremely nice safety net.

Blue Cross and Blue Shield of North Carolina works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Blue Medicare Medical Only (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross and Blue Shield of North Carolina and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Blue Cross and Blue Shield of North Carolina except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in North Carolina.

2023 Blue Cross and Blue Shield of North Carolina Medicare Advantage Plan Overview

What type of plan is Blue Medicare Medical Only (HMO-POS)

Blue Medicare Medical Only (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does Blue Medicare Medical Only (HMO-POS) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Blue Cross and Blue Shield of North Carolina charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Blue Medicare Medical Only (HMO-POS) by Blue Cross and Blue Shield of North Carolina MOOP is $3,900. Once you spend $3,900 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what Blue Medicare Medical Only (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Blue Cross and Blue Shield of North Carolina helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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

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Contact lenses

In-Network Vision	$0 copay

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Eyeglass frames

In-Network Vision	$0 copay

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Eyeglass lenses

In-Network Vision	$0 copay

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Eyeglasses (frames and lenses)

In-Network Vision	$0 copay

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Other

In-Network Vision	$25 copay

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Routine eye exam

In-Network Vision	$25 copay

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Upgrades

In-Network Vision	$0 copay

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In-Network Transportation	$0 copay
Out-of-Network Skilled Nursing Facility	Not Applicable
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $196 per day for days 21 through 60 $0 per day for days 61 through 100

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Occupational therapy visit

In-Network Rehabilitation services	$40 copay

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Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$25 copay

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Cleaning

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	20% coinsurance

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Dental x-ray(s)

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	20% coinsurance

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Fluoride treatment

Out-of-Network Preventive dental	20% coinsurance
In-Network Preventive dental	$0 copay

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Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	20% coinsurance

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In-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$275 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Out-of-Network Mental health services	Not Applicable
In-Network Mental health services	$295 per day for days 1 through 5 $0 per day for days 6 through 90

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Outpatient group therapy visit

In-Network Mental health services	$25 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$25 copay

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Outpatient individual therapy visit

In-Network Mental health services	$25 copay

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$25 copay

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Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance

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Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance

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Diabetes supplies

In-Network Medical equipment/supplies	0-20% coinsurance per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$3,900 In-network
Out-of-Network Inpatient hospital coverage	Not Applicable
In-Network Inpatient hospital coverage	$295 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond

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Fitting/evaluation

In-Network Hearing	$0 copay

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Hearing aids

In-Network Hearing	$699-999 copay

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Hearing exam

In-Network Hearing	$25 copay

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Health plan deductible	$0
In-Network Ground ambulance	$250 copay

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Foot exams and treatment

In-Network Foot care (podiatry services)	$25 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$110 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$60 copay per visit (always covered)

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Primary

In-Network Doctor visits	$0 copay

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Specialist

In-Network Doctor visits	$25 copay per visit

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$0-300 copay or 20% coinsurance

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0-25 copay

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0-5 copay

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$0-15 copay

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	20% coinsurance

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Extractions

Out-of-Network Comprehensive dental	20% coinsurance
In-Network Comprehensive dental	$0 copay

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	20% coinsurance

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Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	20% coinsurance

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Restorative services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	20% coinsurance

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

Blue Medicare Medical Only (HMO-POS) Reviews

Is Blue Medicare Medical Only (HMO-POS) a good plan? Blue Medicare Medical Only (HMO-POS) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Blue Medicare Medical Only Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H3449-012 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Blue Cross and Blue Shield of North Carolina

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Blue Medicare Medical Only (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.