Blue Medicare Medical Only (HMO-POS) Medicare Advantage Plan H3449-012 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3900.00In-network
- Part B Giveback
- −$35.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 6,666 beneficiaries
Blue Medicare Medical Only (HMO-POS) Introduction
CMS Plan ID H3449-012 identifies Blue Medicare Medical Only, a Medicare Advantage HMO-POS plan offered by Blue Cross and Blue Shield of North Carolina. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $3900.00 in-network maximum out-of-pocket.
Plan Benefits
Blue Medicare Medical Only 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 H3449-012.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $25 copay | In-network: $25 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$25 copay | In-network: $0-$25 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$300 copay, 20% coinsurance | In-network: $0-$300 copay, 20% coinsurance |
| Lab services | In-network: $0-$25 copay | In-network: $0-$5 copay |
| Outpatient x-rays | In-network: $0-$30 copay | In-network: $0-$15 copay |
| Diagnostic tests and procedures | In-network: $0-$25 copay | In-network: $0-$25 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $150 copay |
| Worldwide emergency care | Coming soon | $150 copay |
| Urgent care | $65 copay | $65 copay |
| Inpatient hospital care | In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 |
| Ground ambulance | In-network: $250 copay | In-network: $250 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $25 copay | In-network: $25 copay |
| Outpatient group therapy | In-network: $25 copay | In-network: $25 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $295 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $25 copay | In-network: $25 copay |
| Occupational therapy | In-network: $25 copay | In-network: $25 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance | In-network: 20% coinsurance |
| Prosthetics | In-network: 20% coinsurance | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 20%-40% coinsurance |
In-network: $0 copay Out-of-network: 20%-40% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | In-network: $0 copay | In-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $499-$999 copay | In-network: $499-$999 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Blue Medicare Medical Only as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H3449)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| 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 and Blue Shield of North Carolina
- Website
- Blue Cross and Blue Shield of North Carolina Plan Page
- Providers
- Blue Cross and Blue Shield of North Carolina Providers Page
- Formulary
- Blue Cross and Blue Shield of North Carolina Formulary Page
- Pharmacy
- Blue Cross and Blue Shield of North Carolina Pharmacy Page
- New Member Health Plan Help
- (866)760-0823
- New Member Health Plan TTY
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Blue Medicare Medical Only (H3449-012-0) is available in the following locations:
North Carolina Counties Served
- Alamance
- Alexander
- Alleghany
- Anson
- Ashe
- Avery
- Beaufort
- Bertie
- Bladen
- Brunswick
- Buncombe
- Burke
- Cabarrus
- Caldwell
- Camden
- Carteret
- Caswell
- Catawba
- Chatham
- Cherokee
- Chowan
- Clay
- Cleveland
- Columbus
- Craven
- Cumberland
- Currituck
- Dare
- Davidson
- Davie
- Duplin
- Durham
- Edgecombe
- Forsyth
- Franklin
- Gaston
- Gates
- Graham
- Granville
- Greene
- Guilford
- Halifax
- Harnett
- Haywood
- Henderson
- Hertford
- Hoke
- Hyde
- Iredell
- Jackson
- Johnston
- Jones
- Lee
- Lenoir
- Lincoln
- Macon
- Madison
- Martin
- Mcdowell
- Mecklenburg
- Mitchell
- Montgomery
- Moore
- Nash
- New Hanover
- Northampton
- Onslow
- Orange
- Pamlico
- Pasquotank
- Pender
- Perquimans
- Person
- Pitt
- Polk
- Randolph
- Richmond
- Robeson
- Rockingham
- Rowan
- Rutherford
- Sampson
- Scotland
- Stanly
- Stokes
- Surry
- Swain
- Transylvania
- Tyrrell
- Union
- Vance
- Wake
- Warren
- Washington
- Watauga
- Wayne
- Wilkes
- Wilson
- Yadkin
- Yancey
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Blue Medicare Medical Only (HMO-POS)
How much does plan H3449-012 cost per month?
The 2027 monthly premium is $0.00. The Medicare Part B premium is paid separately.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $3900.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the total enrollment for plan H3449-012?
Total enrollment is 6,666 beneficiaries based on the latest CMS data.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Cross and Blue Shield of North Carolina (official source) | https://www.bluecrossnc.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
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.