Medicare HMO Blue ValueRx (HMO) 2026 Plan Details for Suffolk County, Massachusetts Residents
Medicare HMO Blue ValueRx (HMO) 2026 Plan Details for Suffolk County, Massachusetts Residents
Navigating your Medicare Advantage options in Suffolk County for 2026 can be overwhelming, but we're here to help. With Medicare HMO Blue ValueRx (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 5,348 Medicare beneficiaries are enrolled in this plan, with 195 members in Suffolk County, MA.
Medicare HMO Blue ValueRx Overview
| Plan ID H2261-022-1 Overview | |
|---|---|
| Health Plan ID: | H2261-022-1 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $65.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3750.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $320.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Suffolk County, MA |
| Insured By: | Blue Cross Blue Shield of Massachusetts |
Explore the Benefits of Medicare HMO Blue ValueRx
Medicare HMO Blue ValueRx is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that combines hospital, medical, and drug coverage into one streamlined option. With a monthly premium of $65.00, it includes all benefits under Medicare Part A and Part B, along with built-in prescription drug coverage. The annual Part D deductible is $320.00. You’ll typically need to use doctors and providers in the plan’s network, except for emergency situations.
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 all apply toward the plan’s maximum out-of-pocket (MOOP) limit of $3750.00. Once that limit is met, all in-network healthcare services are fully covered for the rest of the year. That’s a major plus for those who want both medical and drug coverage bundled into one predictable package.
This plan is listed by CMS as H2261-022-1. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
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Cost-Sharing Overview
Medicare HMO Blue ValueRx includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H2261-022-1.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $10 copay |
| Specialist: | In-network: $0-$40 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$40 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $140 copay |
| Wordwide emergency care: | $105 copay |
| Urgent care: | $0-$40 copay |
| Inpatient hospital care: | Tier 1 | $350 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 | $160 per day for days 21-44 | $0 per day for days 45-100 |
| Ground ambulance: | In-network: $250 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $25 copay |
| Outpatient group therapy: | In-network: $25 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $350 per day for days 1-7 | $0 per day for days 8-90 | $0 Lifetime Reserve Days for days 1-60 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20 copay |
| Occupational therapy: | In-network: $20 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $250 copay |
| Lab services: | In-network: $0-$10 copay |
| Outpatient x-rays: | In-network: $10 copay |
| Diagnostic tests and procedures: | In-network: $0-$10 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| 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 |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | In-network: $0 copay |
| 'Wigs for chemotherapy hair loss: | In-network: $0 copay |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Medicare HMO Blue ValueRx as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Medicare HMO Blue ValueRx includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $36.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $36.00 |
| Low-Income Premium Subsidy: | $35.76 |
| Low-Income Premium Subsidy Paid by CMS: | $35.80 |
| Low-Income Subsidy Premium: | $0.20 |
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.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $6.00 copay | Coming soon |
| Preferred Brand | $42.00 copay | Coming soon |
| Non-Preferred Drug | $95.00 copay | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Medicare HMO Blue ValueRx
You are eligible to enroll in Medicare HMO Blue ValueRx if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for Medicare HMO Blue ValueRx and take advantage of its full range of benefits.
When Should You Enroll in Medicare HMO Blue ValueRx?
Knowing when you can enroll in Medicare HMO Blue ValueRx is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Enroll in Medicare HMO Blue ValueRx
Getting started with Medicare HMO Blue ValueRx is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Medicare HMO Blue ValueRx. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID H2261-022-1:
How much does H2261-022-1 cost per month?
For 2026, the monthly premium is $65.00, and you still pay your Part B premium to Medicare.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $3750.00, protecting you from larger bills once you hit that limit.
Is there a Part D deductible with this plan?
Yes. The Part D deductible is $320.00.
How is this plan rated by Medicare?
CMS rates it ★4.5 out of 5 stars for 2026.
How many people are enrolled in this plan?
CMS reports 5,348 members in the latest file.
Contact Blue Cross Blue Shield of Massachusetts
| Contact Type | Details |
|---|---|
| Website: | Blue Cross Blue Shield of Massachusetts Plan Page |
| New Members: | 1-800-678-2265 |
| Existing Members: | 1-800-200-4255 |
| Plan Address: | P.O. Box 55011 | Boston, MA 02205 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Blue Cross Blue Shield of Massachusetts, http://www.bluecrossma.com/medicare — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
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Page content managed by David Bynon, Medicare Analyst.
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