True Blue Rx 32PSP (HMO)
Available to residents of Boise County, ID for 2026. Contract H1350, plan 032, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Boise County
- Plan website
- Browse the True Blue Rx 32PSP (HMO) formulary
New for 2026. This plan has no 2025 predecessor in the CMS crosswalk.
Plan details
| Monthly premium (Part C + D) | $16.00 |
|---|---|
| — medical (Part C) part | $16.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $16.00?drug (Part D) part $0.00; Extra Help does not cover the medical (Part C) premium |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | $900.00 |
| In-network out-of-pocket maximum | $5,900.00? |
| Drug deductible | $175.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO? |
| Contract / plan | H1350-032-0 |
| Offered by | Blue Cross of Idaho |
| Parent organization | Gemstone Holdings, Inc. |
| Formulary drugs | 3,026 |
| Formulary exception tier | 4? |
| Pharmacy search | bcidaho.com/FindAPharmacy |
| Member services | (888)492-2583TTY 711 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H1350 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $40 copay(referral required) |
| Other health care professional | $0–$40 copay(authorization and referral required) |
| Additional telehealth services | $0–$40 copay(referral required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay(referral required) |
| Glaucoma screening | $0 copay(referral required) |
| Diabetes self-management training | $0 copay(referral required) |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $35 copay(authorization and referral required) |
| Lab services | $0 copay(authorization and referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$350 copay(authorization and referral required) |
| Therapeutic radiology | 20% coinsurance(authorization and referral required) |
| Outpatient x-rays | $25 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $130 copay |
| Urgent care | $50 copay |
| Worldwide emergency coverage | $0 copay |
| Worldwide urgent care | $0 copay |
| Worldwide emergency transportation | $0 copay |
| Hospital care | |
| Inpatient hospital stay | $425 per day for days 1–5; $0 per day for days 6–90(authorization and referral required) |
| Outpatient hospital services | $0–$500 copay; 20% coinsurance(authorization and referral required) |
| Outpatient observation | $500 copay(authorization and referral required) |
| Ambulatory surgical center | $0–$250 copay; 20% coinsurance(authorization and referral required) |
| Outpatient blood services | $0 copay(referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–55; $0 per day for days 56–100(authorization and referral required) |
| Home health care | $0 copay(referral required) |
| Kidney dialysis | 20% coinsurance(referral required) |
| Rehabilitation | |
| Occupational therapy | $40 copay(referral required) |
| Physical therapy and speech-language therapy | $40 copay(referral required) |
| Cardiac rehabilitation | $0 copay(referral required) |
| Pulmonary rehabilitation | $0 copay(referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $425 per day for days 1–5; $0 per day for days 6–90(authorization and referral required) |
| Outpatient mental health, individual session | $35 copay(referral required) |
| Outpatient mental health, group session | $35 copay(referral required) |
| Psychiatrist, individual session | $40 copay(referral required) |
| Psychiatrist, group session | $40 copay(referral required) |
| Partial hospitalization | $140 copay(authorization and referral required) |
| Intensive outpatient program | $140 copay(authorization and referral required) |
| Outpatient substance use, individual session | $35 copay(referral required) |
| Outpatient substance use, group session | $35 copay(referral required) |
| Opioid treatment program | $0 copay(referral required) |
| Ambulance and transportation | |
| Ground ambulance | $320 copay(authorization required) |
| Air ambulance | $320 copay(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay |
| Diabetic therapeutic shoes or inserts | 20% coinsurance |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay(referral required) |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $40 copay(referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $40 copay |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay(authorization and referral required) |
| Routine eye exam | $0 copay(authorization and referral required, limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(authorization and referral required, limits apply) |
| Contact lenses | $0–$35 copay(authorization and referral required, limits apply) |
| Eyeglasses (frames and lenses) | $35 copay(authorization and referral required, limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | $0 copay(authorization and referral required, limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $20 copay(referral required) |
| Routine hearing exam | $0 copay(referral required, limits apply) |
| Hearing aid fitting and evaluation | $0 copay(referral required) |
| Hearing aids (all types) | $499–$999 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Not covered |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $6.00 |
| Tier 3 | $40.00 |
| Tier 4 | 25% |
| Tier 5 | 28% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $6.00 | $15.00 | $6.00 | $18.00 | $45.00 | $18.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $6.00 | $15.00 | $6.00 | $18.00 | $45.00 | $18.00 |
| Tier 3: Preferred Brand | $40.00 | $47.00 | $40.00 | $120.00 | $141.00 | $120.00 |
| Tier 4: Non-Preferred Drug | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 28% | 28% | 28% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 5 other ID counties
Benefits in plain text
True Blue Rx 32PSP (HMO) (H1350-032-0) is a 2026 HMO Medicare Advantage plan offered by Blue Cross of Idaho, available to residents of Boise County, ID.
The monthly premium is $16.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $16.00.
The in-network deductible for health services is $900.00.
Its in-network out-of-pocket maximum is $5,900.00.
The drug deductible is $175.00. Tier 1 and 2 exempt.
The plan's formulary lists 3,026 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $6.00; tier 3: $40.00; tier 4: 25%; tier 5: 28%.
CMS gives the plan's contract (H1350) an overall rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.