Blue Shield 65 Plus (HMO)
Blue Shield of California · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $65
- Highest of 10 plans here
- Most you pay in a year for covered care in network
- $4,100
- Higher than most plans here
- Drug deductible
- $425
- Medicare star rating
- 4 of 5
In plain English
Compared with the 9 other plans in San Luis Obispo County that the same person could join.
What stands out
- Dental, vision and hearing extras included
Watch out for
- $65 monthly premium, highest of 10 plans here
- Up to $4,100 a year for covered care, higher than most plans here
- $2,000 for a 5-day hospital stay, highest of 9 plans here
- $150 for the emergency room, tied for highest here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$780$780 in premiums + $0 for careHighest of 10 plans here2 checkups and 2 lab tests.
- A busier year$780$780 in premiums + $0 for careHighest of 10 plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$3,415$780 in premiums + $2,635 for careHighest of 10 plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral needed
- Urgent care$0
- Emergency room$150Tied for highest hereNot charged if you stay in the hospital within 1 days
- Hospital stay$500 a day for days 1 to 4, then $0 for days 5 to 90Highest of 9 plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$50Referral neededPlan approval may be needed
- Outpatient hospital care$200Tied for highest here
- X-rays$0Referral needed
- MRI, CT and other scans$100Highest of 6 plans hereReferral needed
- Ground ambulance$285Higher than most plans herePlan approval may be needed
- Skilled nursing facility$10 a day for days 1 to 20, then $200 a day for days 21 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 9 other plans in San Luis Obispo County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $5 |
| 2Generic | $5 | $12 |
| 3Preferred BrandAfter the deductible | 25% of the price | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 30% of the price | 30% of the price |
| 5Specialty TierAfter the deductible | 28% of the price | 28% of the price |
For a 1-month supply. The $425 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: 0% to 20%.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear has a limit; ask the plan.
- Hearing IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items Not included
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Blue Shield 65 Plus (HMO), plan number H0504-039, for 2026?”