Medicare HMO Blue PlusRx (HMO) Medicare Advantage Plan H2261-005 • 2027 • Worcester County, MA
- Monthly Premium
- $245.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3800.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $500.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Worcester County, MA
- Local Enrollment
- 356 beneficiaries in Worcester County
Medicare HMO Blue PlusRx (HMO) Introduction
CMS Plan ID H2261-005 identifies Medicare HMO Blue PlusRx, a Medicare Advantage HMO plan offered by Blue Cross Blue Shield of Massachusetts. The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $245.00 monthly premium, $0.00 medical deductible, and $3800.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $500.00.
This plan is available to eligible beneficiaries who live in Worcester County, Massachusetts. CMS reports local enrollment of 356 beneficiaries for this plan in Worcester County. New members can contact the plan at (800)678-2265 (TTY 711) for help and additional plan information.
Compare Similar Plans in Worcester County
Compare this plan with the two most-enrolled HMO plans available in Worcester County, Massachusetts. Enrollment is based on CMS local enrollment data.
| Plan Detail | Medicare HMO Blue PlusRx | Tufts Medicare Preferred HMO Basic Rx | Tufts Medicare Preferred HMO Prime Rx |
|---|---|---|---|
| CMS Plan ID | H2261-005-0 |
H2256-036-0 |
H2256-033-0 |
| Local Enrollment | 356 | 2,975 | 1,492 |
| Monthly Premium | $245.00 | $85.00 | $224.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $3,800.00 | $4,500.00 | $3,850.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $10 copay | $10 copay |
| Specialist | $0-$30 copay | $45 copay | $30 copay |
| Part D Deductible | $500.00 | $200.00 | $0.00 |
| CMS Star Rating | 4.5 | 4.0 | 4.0 |
| Dental | $0 copay | 0%-50% coinsurance | Not covered |
| Vision | $0 copay | $15 copay | $15 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Worcester County, or compare Medicare Advantage plans across Massachusetts, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
Medicare HMO Blue PlusRx includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H2261-005.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H2261-005-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0-$30 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$30 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $150 copay
- Lab services
- In-network: $0 copay
- Outpatient x-rays
- In-network: $5 copay
- Diagnostic tests and procedures
- In-network: $0 copay
Emergency and Urgent Care Services
- Emergency room care
- $140 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0-$30 copay
- Inpatient hospital care
- Tier 1
$137 per day for days 1-7
$0 per day for days 8-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$100 per day for days 21-44
$0 per day for days 45-100 - Ground ambulance
- In-network: $150 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $10 copay
- Outpatient group therapy
- In-network: $10 copay
- Inpatient psychiatric hospital care
- Tier 1
$137 per day for days 1-7
$0 per day for days 8-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $15 copay
- Occupational therapy
- In-network: $15 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 10% coinsurance
- Prosthetics
- In-network: 10% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-10% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-10% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $699-$999 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- In-network: $0 copay
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Medicare HMO Blue PlusRx as a Part B benefit.
Prescription Drug Coverage
Medicare HMO Blue PlusRx 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 Advantage 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $145.10 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $145.10 |
| Low-Income Premium Subsidy: | $33.82 |
| Low-Income Premium Subsidy Paid by CMS: | $33.80 |
| Low-Income Subsidy Premium: | $111.30 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $500.00 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 PlusRx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | $42.00 copay | Coming soon |
| Non-Preferred Drug | $95.00 copay | Coming soon |
| Specialty Tier | 27% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2261)
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.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Blue Cross Blue Shield of Massachusetts
- Website
- Blue Cross Blue Shield of Massachusetts Plan Page
- Providers
- Blue Cross Blue Shield of Massachusetts Providers Page
- Formulary
- Blue Cross Blue Shield of Massachusetts Formulary Page
- Pharmacy
- Blue Cross Blue Shield of Massachusetts Pharmacy Page
- New Member Health Plan Help
- (800)678-2265
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (800)678-2265
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Advantage Plan Availability
Medicare HMO Blue PlusRx is available to eligible Medicare beneficiaries residing in Worcester County, Massachusetts, including communities such as Barre, Oakham, Warren, Athol, Fitchburg, Ashburnham, Baldwinville, Gardner, Harvard, Hubbardston, Leominster, Lunenburg, Templeton, Westminster, Winchendon, Auburn, Berlin, Blackstone, Boylston, Brookfield, Charlton, Clinton, East Brookfield, Douglas, Fiskdale, Grafton, Holden, Jefferson, Lancaster, Leicester, Millbury, Millville, Northborough, Northbridge, North Brookfield, North Grafton, North Oxford, Oxford, Princeton, Rochdale, Rutland, Shrewsbury, Southbridge, South Grafton, Spencer, Sterling, Sturbridge, Upton, Uxbridge, Webster, Dudley, Westborough, West Boylston, West Brookfield, Whitinsville, Sutton, Worcester, Cherry Valley, Paxton, Bolton, Hopedale, Mendon, Milford, Southborough, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Cross Blue Shield of Massachusetts (official source) | http://www.bluecrossma.com/medicare | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.