2026 Medicare benefits at-a-glance Blue Medicare Essential Plus (HMO-POS) SM Segment 1 Segment 2 Segment 4 Segment 5 Plan Benefits H3449-023-001 H3449-023-002 H3449-023-004 H3449-023-005 Premium $0 $0 $0 $0 Annual maximum In-network: $4,900 $5,400 $6,750...
More
2026 Medicare benefits at-a-glance Blue Medicare Essential Plus (HMO-POS) SM Segment 1 Segment 2 Segment 4 Segment 5 Plan Benefits H3449-023-001 H3449-023-002 H3449-023-004 H3449-023-005 Premium $0 $0 $0 $0 Annual maximum In-network: $4,900 $5,400 $6,750 $7,450 out-of-pocket Primary care provider: $0 copay $0 copay $0 copay $0 copay Physician Specialist: $20 copay $25 copay $30 copay $40 copay Hospital* Days 1-6: $400 copay $400 copay $400 copay $400 copay (Cost share applies per day. Benefit period applied Additional $0 copay $0 copay $0 copay $0 copay per admission.) unlimited days: Outpatient hospital: $0-$400 copay $0-$400 copay $0-$400 copay $0-$400 copay Outpatient services*,** Ambulatory $0-$350 copay $0-$350 copay $0-$350 copay $0-$350 copay surgical center: Skilled Days 1–20: $0 copay $0 copay $0 copay $0 copay nursing facility* Days 21–100: $218 copay $218 copay $218 copay $218 copay Diagnostic services/labs/imaging*,** $0–$300 copay $0–$300 copay $0–$300 copay $0–$300 copay
Less
