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True Blue Rx Extend (HMO)

H1350 - 023 - 2
3.5 out of 5 stars (3.5 / 5)

True Blue Rx Extend (HMO) is a Medicare Advantage Plan by Blue Cross of Idaho.

This page features plan details for 2025 True Blue Rx Extend (HMO) H1350 – 023 – 2 available in Select Counties in Idaho.

Locations

True Blue Rx Extend (HMO) is offered in the following locations.

Gooding County, Idaho
Idaho
Jerome County, Idaho

Click to see more locations

Plan Overview

True Blue Rx Extend (HMO) offers the following coverage and cost-sharing.

Insurer:Blue Cross of Idaho
Health Plan Deductible:$0
MOOP:$4,200 In-network
Drugs Covered:Yes

Ready to sign up for True Blue Rx Extend (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

True Blue Rx Extend (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

True Blue Rx Extend (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $100.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $100.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

True Blue Rx Extend (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply, Authorization Required)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Implant Services
    • In-Network: No Coins – 300.00 Copay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Limits Apply, Authorization Required)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Prosthodontics, fixed
    • In-Network: No Coins – 300.00 Copay (Authorization Required)
  • Prosthodontics, removable
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – – Copay
  • Fluoride Treatment
    • In-Network: No Coins – – Copay
  • Oral Exams
    • In-Network: No Coins – – Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – – Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • $0-30 copay or 0-20% coinsurance (Authorization Required)
  • Lab services
    • $0 copay (Authorization Required)
  • Outpatient x-rays
    • $0 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-150 copay (Authorization Required)

Doctor visits

  • Primary
    • $0 copay
  • Specialist
    • $0-20 copay per visit

Emergency care/Urgent care

  • Urgent care
    • $40 copay per visit (always covered)
  • Emergency
    • $100 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • $25 copay

Ground ambulance

    • $200 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay
  • Hearing aids
    • $499-999 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • $25 copay

Inpatient hospital coverage

    • $225 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $4,200 In-network

Medical equipment/supplies

  • Diabetes supplies
    • $0 copay per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 0-20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 0-20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • $225 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • $0 copay
  • Outpatient group therapy visit with a psychiatrist
    • $25 copay
  • Outpatient individual therapy visit
    • $0 copay
  • Outpatient individual therapy visit with a psychiatrist
    • $25 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $0-150 copay per visit (Authorization Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Occupational therapy visit
    • $20 copay
  • Physical therapy and speech and language therapy visit
    • $0-20 copay

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $203 per day for days 21 through 55
      $0 per day for days 56 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Other
    • Not covered
  • Routine eye exam
    • $0 copay (Limits Apply, Authorization Required)
  • Eyeglass frames
    • Not covered
  • Contact lenses
    • $0-35 copay (Limits Apply, Authorization Required)
  • Eyeglasses (frames and lenses)
    • $35 copay (Limits Apply, Authorization Required)
  • Upgrades
    • $0 copay (Limits Apply, Authorization Required)
  • Eyeglass lenses
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for True Blue Rx Extend (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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