Blue Shield Value Advantage Plan (HMO)
Blue Shield of California · HMO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $199
- Lowest of 58 plans here
- Drug deductible
- $300
- Medicare star rating
- No rating yet
In plain English
Compared with the 57 other plans in Los Angeles County that the same person could join.
What stands out
- No monthly premium
- At most $199 a year for covered care, lowest of 58 plans here
- $0 for a 5-day hospital stay, tied for lowest here
- Dental, vision and hearing extras included
Watch out for
- 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$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for careTied for lowest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$199$0 in premiums + $199 for careLower 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.Stops at the plan’s yearly limit.
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$0Tied for lowest hereReferral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0Referral neededPlan approval may be needed
- Outpatient hospital care$150Higher than most plans here
- X-rays$0Referral needed
- MRI, CT and other scans$0Referral needed
- Ground ambulance$200Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $75 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 57 other plans in Los Angeles 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 | $0 | $10 |
| 3Preferred BrandAfter the deductible | 23% of the price | 23% of the price |
| 4Non-Preferred DrugAfter the deductible | 28% of the price | 28% of the price |
| 5Specialty TierAfter the deductible | 30% of the price | 30% of the price |
For a 1-month supply. The $300 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 $140 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 Included24 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 Value Advantage Plan (HMO), plan number H0504-056, for 2027?”