Medicare HMO Blue ValueRx (HMO) Medicare Advantage Plan H2261-022-1 • 2026 • Norfolk County, MA

Medicare HMO Blue ValueRx Overview

Plan Overview for Medicare HMO Blue ValueRx

Medicare HMO Blue ValueRx is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $65.00, and services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $320.00.

Primary care visits have a $10 copay, specialist visits come with a $0-$40 copay, urgent care services carry a $0-$40 copay, and ambulance transportation is $250 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3750.00. After this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H2261-022-1. Cost-sharing details for key services are provided below.

Cost-Sharing Overview

Medicare HMO Blue ValueRx includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H2261-022-1.

Certain preventive services are covered 100% by Medicare HMO Blue ValueRx as a Part B benefit.

Prescription Drug Coverage

Medicare HMO Blue ValueRx includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $320.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Cross Blue Shield of Massachusetts starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Medicare HMO Blue ValueRx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Medicare Plan Star Ratings

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.