Blue Shield Advantage (HMO)
Blue Shield of California · HMO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $19
- Higher than most plans here
- Most you pay in a year for covered care in network
- $3,900
- Drug deductible
- $475
- Higher than most plans here
- Medicare star rating
- No rating yet
In plain English
Compared with the 15 other plans in Sacramento County that the same person could join.
What stands out
- Dental, vision and hearing extras included
Watch out for
- $19 monthly premium, higher than most plans here
- $475 drug deductible, higher than most plans here
- You need a referral to see a specialist
- Covers only the plan’s own doctors and hospitals, except in an emergency or for urgent care
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$228$228 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$228$228 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$1,863$228 in premiums + $1,635 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$150Not charged if you stay in the hospital within 1 days
- Hospital stay$200 a day for days 1 to 5, then $0 for days 6 to 90Referral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$150Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$300Highest of 9 plans here
- X-rays$0Referral needed
- MRI, CT and other scans$100Higher 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
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 15 other plans in Sacramento County that the same person could join. Read the plan’s 2027 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $5 |
| 2Generic | $5 | $12 |
| 3Preferred BrandAfter the deductible | 21% of the price | 21% of the price |
| 4Non-Preferred DrugAfter the deductible | 26% of the price | 26% of the price |
| 5Specialty TierAfter the deductible | 28% of the price | 28% of the price |
For a 1-month supply. The $475 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 2027, 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 IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items IncludedUp to $25 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes, a home fitness kit and an activity tracker.
- 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 Advantage (HMO), plan number H0504-053, for 2027?”