Blue Shield AdvantageOptimum 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
- $3,600
- Higher than most plans here
- Drug deductible
- $350
- Medicare star rating
- No rating yet
In plain English
Compared with the 69 other plans in Los Angeles County that the same person could join.
What stands out
- No monthly premium
Watch out for
- Up to $3,600 a year for covered care, higher than most plans here
- No hearing extra, though most plans here have one
- 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$740$0 in premiums + $740 for care6 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$50 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$50Higher than most plans hereReferral neededPlan approval may be needed
- Outpatient hospital care$200Higher than most plans here
- X-rays$0Referral needed
- MRI, CT and other scans$20Higher than most plans hereReferral needed
- Ground ambulance$300Higher than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $175 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 69 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 | 15% of the price | 15% of the price |
| 4Non-Preferred DrugAfter the deductible | 25% of the price | 25% of the price |
| 5Specialty TierAfter the deductible | 29% of the price | 29% of the price |
For a 1-month supply. The $350 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 covered. Fillings, crowns and dentures covered.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear has a limit; ask the plan.
- Hearing Not included
- Over-the-counter items Not included
- Fitness IncludedIncludes gym or fitness classes, a home fitness kit and an activity tracker.
- Rides to care Included10 one-way rides to medical visits a year.
What changed from 2026
- Most you pay in a year2026$3,1002027$3,600
- Drug deductible2026$4252027$350
- Over-the-counter items2026Up to $65 every three months for things like vitamins, pain relief and bandages. Unused money does not carry over2027Not covered
- Fitness2026Includes gym or fitness classes2027Includes gym or fitness classes, a home fitness kit and an activity tracker
- Rides to care202614 one-way rides to medical visits a year202710 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 AdvantageOptimum Plan (HMO), plan number H5928-004, for 2027?”