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
- $58
- Higher than most plans here
- Most you pay in a year for covered care in network
- $5,300
- Higher than most plans here
- Drug deductible
- $425
- Higher than most plans here
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- 4 of 5
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
Watch out for
- $58 monthly premium, higher than most plans here
- Up to $5,300 a year for covered care, higher than most plans here
- $1,375 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$696$696 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$696$696 in premiums + $0 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,636$696 in premiums + $1,940 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.
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$130Not charged if you stay in the hospital within 1 days
- Hospital stay$275 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, scans, mental health, therapy, home health and more
- Outpatient surgery center$150Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$300Higher than most plans here
- X-rays$0Referral needed
- MRI, CT and other scans$75Higher than most plans hereReferral needed
- Ground ambulance$285Higher 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
- Mental health therapy visit$30Higher than most plans hereReferral neededPlan approval may be needed
- Psychiatrist visit$30Higher than most plans hereReferral neededPlan approval may be needed
- Physical or speech therapy$10Higher than most plans hereReferral neededPlan approval may be needed
- Occupational therapy$10Higher than most plans hereReferral neededPlan approval may be needed
- Home health care$0Referral neededPlan approval may be needed
- Medical equipment, like a walker or oxygen0% to 20%Depends on the servicePlan approval may be needed
- Kidney dialysis20%Referral neededPlan approval may be needed
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab$25Highest of 22 plans hereReferral neededPlan approval may be needed
- Foot doctor (podiatrist)$0Referral needed
- Chiropractor$0Referral 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 25 other plans in Santa Clara County that the same person could join. Read the plan’s 2026 booklet (PDF)
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take Blue Shield Inspire (HMO), plan number H0504-047, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| 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 IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear has a limit; ask the plan.
- Hearing Not included
- Over-the-counter items IncludedUp to $35 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 Not included
- Other extras IncludedIncludes a nurse phone line or online visits.
Add-ons you can buy
Optional. Each costs extra every month, on top of the plan premium.
- Dental HMO$16 a month · Adds dental
- Dental PPO$49 a month · Adds dental$50 deductible.
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
The drug part of this plan’s premium is already $0, so Extra Help would not lower the premium (the $58 medical part stays).
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(888) 534-4263 · TTY 711
- Plan websiteblueshieldca.com/medicare
- List of covered drugsblueshieldca.com/medformulary2026
- Find a pharmacyblueshieldca.com/medpharmacy2026
- Full 2026 rulesRead the plan’s booklet (PDF)
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.