2020 True Blue no Rx (HMO) H1350-006 By Blue Cross of Idaho.

2020 Medicare Advantage Plan Services for
True Blue no Rx (HMO)

True Blue no Rx (HMO) H1350-006 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Blue Cross of Idaho available to residents in Idaho. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The True Blue no Rx (HMO) has a monthly premium of $29.00 and has an in-network Maximum Out-of-Pocket limit of $3,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,000 out of pocket. This can be a extremely nice safety net.

True Blue no Rx (HMO) 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 PCP 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 PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Blue Cross of Idaho works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for True Blue no Rx (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross of Idaho and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Blue Cross of Idaho except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

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Sun 9am-6pm EST

2020 Blue Cross of Idaho Medicare Advantage Plan Details

True Blue no Rx (HMO)
Provider:Blue Cross of Idaho
Type: Local HMO *
Monthly Premium C+D: $29.00
Part C Premium:
MOOP: $3,000

2019 Plan Services

(*2020 Plan services will be added when available)

Health plan deductible


Emergency care/Urgent care

Emergency $90 per visit (always covered)
Urgent care $25 per visit (always covered)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures $0 copay
Lab services $0 copay
Diagnostic radiology services (e.g., MRI) $175
Outpatient x-rays $0 copay


Hearing exam $45
Fitting/evaluation Not covered
Hearing aids $699-999

Preventive dental

Office visit $10.00
Oral exam Covered under office visit
Cleaning Covered under office visit
Fluoride treatment Not covered
Dental x-ray(s) Covered under office visit

Comprehensive dental

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


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

Mental health services

Inpatient hospital - psychiatric $100 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist $25
Outpatient individual therapy visit with a psychiatrist $25
Outpatient group therapy visit $25
Outpatient individual therapy visit $25

Skilled Nursing Facility

$0 per day for days 1 through 20
$150 per day for days 21 through 100

Rehabilitation services

Occupational therapy visit $15
Physical therapy and speech and language therapy visit $15

Ground ambulance


Other health plan deductibles?

In-Network No


Not covered

Foot care (podiatry services)

Foot exams and treatment $25
Routine foot care Not covered

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen) 10% per item
Prosthetics (e.g., braces, artificial limbs) 10% per item
Diabetes supplies $0 copay

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


Medicare Part B drugs

Chemotherapy 10%
Other Part B drugs 10%

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

$3,000 In-network

Optional supplemental benefits


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

In-Network No

Inpatient hospital coverage

$100 per day for days 1 through 5
$0 per day for days 6 through 90

Outpatient hospital coverage

$100 per visit

Doctor visits

Primary $10 per visit
Specialist $25 per visit

Preventive care

$0 copay

Ratings for True Blue no Rx (HMO) H1350

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in True Blue no Rx (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for True Blue no Rx (HMO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

True Blue no Rx (HMO) Drug Plan Customer Service ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

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Sun 9am-6pm EST

Coverage Area for True Blue no Rx (HMO)

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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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