Blue Shield Inspire (HMO)
Blue Shield of California · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $56
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,500
- Higher than most plans here
- Drug deductible
- $425
- Higher than most plans here
- Medicare star rating
- 4 of 5
In plain English
Compared with the 21 other plans in San Mateo County that the same person could join.
What stands out
- Dental, vision and hearing extras included
Watch out for
- $56 monthly premium, higher than most plans here
- Up to $4,500 a year for covered care, higher than most plans here
- $1,400 for a 5-day hospital stay, higher than most plans here
- $425 drug deductible, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$672$672 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$712$672 in premiums + $40 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Uses the highest listed cost for: Specialist visit.
- A hard year$2,772$672 in premiums + $2,100 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: Specialist visit.
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$0 to $10Depends on the serviceReferral needed
- Urgent care$0
- Emergency room$130Not charged if you stay in the hospital within 1 days
- Hospital stay$280 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$100Referral neededPlan approval may be needed
- Outpatient hospital care$250Tied for highest here
- X-rays$0Referral needed
- MRI, CT and other scans$85Higher than most plans hereReferral needed
- Ground ambulance$280Higher than most plans herePlan approval may be needed
- Skilled nursing facility$0 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 21 other plans in San Mateo 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 | 24% of the price | 24% of the price |
| 4Non-Preferred DrugAfter the deductible | 29% of the price | 29% 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.
- Vision IncludedRoutine eye exam covered. Glasses or contacts covered.Eyewear has a limit; ask the plan.
- Hearing IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items IncludedUp to $40 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included12 one-way rides to medical visits a year.
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 Inspire (HMO), plan number H0504-041, for 2026?”