True Blue Rx Gem (HMO)

Idaho Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$38
by Blue Cross of Idaho

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.5
out of 5 stars

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Plan Name
True Blue Rx Gem (HMO)
Insurance Carrier
Blue Cross of Idaho
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

True Blue Rx Gem (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Idaho and offered by the health insurance company Blue Cross of Idaho. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$38
Annual Deductible
$0
Max Out-of-Pocket
$5,200
Primary doctor visit
$10 copay per visit
Specialist visit
$40 copay per visit
ER visit
$100 copay per visit (always covered)
Ambulance
$325 copay

True Blue Rx Gem (HMO) has a monthly premium cost of $38 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,200 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for True Blue Rx Gem (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

True Blue Rx Gem (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. True Blue Rx Gem (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. True Blue Rx Gem (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, True Blue Rx Gem (HMO) received an overall government quality rating of 4.5 stars out of 5 stars.

True Blue Rx Gem (HMO) performed better than Idaho’s State average overall quality score of 4.0 stars.

This Plan’s 5-star Gov’t Quality Score
Idaho State Average Score
Overall Government 5 Star Quality Rating
 4.5
 4.0
Summary rating of health plan quality
 4.5
 4.0
Staying healthy: screenings, tests, & vaccines
 3
 3.5
Managing chronic (long term) conditions
 3
 3.4
Member experience with health plan
 4
 3.8
Member complaints & changes in the health plan's performance
 5
 4.2
Health plan customer service
 4
 4.3
Summary rating of drug plan quality
 4.5
 4.1
Drug plan customer service
 4
 3.9
Member complaints & changes in the drug plan's performance
 5
 4.6
Member experience with the drug plan
 4
 3.7
Drug safety & accuracy of drug pricing
 3
 3.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

True Blue Rx Gem (HMO) received 4.5 stars for its health plan quality score which is better than the Idaho State average health plan quality score of 4.0 stars.

True Blue Rx Gem (HMO) received 4.5 stars for its drug plan quality score which is better than the Idaho State average drug plan quality score of 4.1 stars.


Monthly Premium
$38
Health Portion of Premium
$38
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,200 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$10 copay per visit
Specialist visit
$40 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$30 copay or 20% coinsurance
Lab services
$15 copay
Diagnostic radiology services (like MRI)
$0-200 copay
Outpatient x-rays
$15 copay
Emergency care
$100 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$350 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
$0-300 copay per visit

Skilled nursing facility

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

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$325 copay

Therapy services

Occupational therapy visit
$40 copay
Physical therapy & speech & language therapy visit
$40 copay

Mental health services

Outpatient group therapy with a psychiatrist
$40 copay
Outpatient individual therapy with a psychiatrist
$40 copay
Outpatient group therapy visit
$20 copay
Outpatient individual therapy visit
$20 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$3.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$10.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug
Specialty Tier30%

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$40 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$499-999 copay

Preventive Dental

Oral exam
Covered under office visit
Cleaning
Covered under office visit
Fluoride treatment
Covered under office visit
Dental x-rays
Covered under office visit

Comprehensive dental

Non-routine services
$0 copay
Diagnostic services
Not covered
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
$20 copay
Contact lenses
$0-35 copay
Eyeglasses (frames & lenses)
$35 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
$0 copay

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