Medicare Plan Lookup Official CMS data · Contract Year 2027
CMS 2027 data

2027 Medicare plan code

H3449-012

Medicare Plan

Blue Medicare Medical Only (HMO-POS) · Blue Cross and Blue Shield of North Carolina · HMOPOS · Select North Carolina Counties

Full CMS plan ID: H3449-012-000

H3449-012-000 is the full CMS identifier for the H3449-012 Medicare plan. Common searches include H3449 012 and H3449012.

2027

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2027 plan record

Blue Medicare Medical Only (HMO-POS)

H3449-012-000 Select North Carolina Counties HMOPOS

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–6 $295 / day
Days 7–90 $0 / day
Total of listed copays · 6 charged days $1,770
Out-of-network

Not separately reported

Point of service

Not separately reported

02

Emergency transport

Ambulance

Ground · in-network$250 copay
Air · in-network$250 copay
03

Emergency services

Emergency room

$150 copay

Waived if admitted within 48 hours

04

Medical maximum

Maximum out-of-pocket

In-network$3,900
Combined in + outNo combined out-of-pocket maximum
05

Skilled care at home

Home health

In-network$0 copay
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + DNot reported

CMS reports a Part B premium reduction of $35 per month.

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkPrimary Care Physician Services: $0 copay
Out-of-networkNot separately reported

Specialist

In-networkPhysician Specialist Services: $25 copay
Out-of-networkNot separately reported

Preventive care

In-networkAnnual Physical Exam: $0 copay; Kidney Disease Education Services: $0 copay; Glaucoma Screening: $0 copay; Diabetes Self-Management Training: $0 copay; Digital Rectal Exams: $0 copay; EKG following Welcome Visit: $0 copay
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkDiagnostic Procedures/Tests: $0–$25 copay
Out-of-networkNot separately reported

Laboratory services

In-networkLab Services: $0–$25 copay
Out-of-networkNot separately reported

X-rays & standard imaging

In-networkOutpatient X-Ray Services: $0–$30 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-networkDiagnostic Radiological Services: 20% coinsurance + $0–$300 copay
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkUrgently Needed Services: $65 copay
Out-of-networkNot separately reported

Emergency room

In-network$150 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$250 copay
Out-of-networkNot separately reported

Air ambulance

In-network$250 copay
Out-of-networkNot separately reported

Outpatient hospital

In-networkOutpatient Hospital Services: $0–$275 copay; Observation Services: $0 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-networkAmbulatory Surgical Center (ASC) Services: $0–$225 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-network$0 copay
Out-of-networkNot separately reported

Skilled nursing facility

In-networkSkilled nursing facility: Tier 1: $0 / day for days 1–20; $221 / day for days 21–100
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCardiac Rehabilitation Services: $20 copay; Intensive Cardiac Rehabilitation Services: $20 copay; Pulmonary Rehabilitation Services: $15 copay; SET for PAD Services: $25 copay; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-networkNot separately reported

Occupational therapy

In-networkOccupational Therapy Services: $25 copay
Out-of-networkNot separately reported

Physical & speech therapy

In-networkPhysical Therapy and Speech-Language Pathology Services: $25 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-networkPartial Hospitalization Program: $40 copay; Individual Sessions for Mental Health Specialty Services: $25 copay; Group Sessions for Mental Health Specialty Services: $25 copay; Individual Sessions for Psychiatric Services: $25 copay; Group Sessions for Psychiatric Services: $25 copay; Inpatient psychiatric hospital: Tier 1: $295 / day for days 1–5; $0 / day for days 6–90
Out-of-networkNot separately reported

Substance use treatment

In-networkIntensive Outpatient Program Services: $40 copay; Individual Sessions for Outpatient Substance Abuse: $25 copay; Group Sessions for Outpatient Substance Abuse: $25 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-networkPodiatry Services: $25 copay; 7f(NMC): Not applicable
Out-of-networkNot separately reported

Chiropractic

In-networkChiropractic Services: $20 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-networkMedicare Dental Services: $25 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Restorative Services: $0 copay; Endodontics: $0 copay; Periodontics: $0 copay; Prosthodontics, removable: $0 copay; Oral and Maxillofacial Surgery: $0 copay; Adjunctive General Services: $0 copay
Out-of-networkNot separately reported

Vision

In-networkEye Exams: $0–$25 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: $25 copay; Eyewear: 20% coinsurance; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: $0 copay; Eyeglass frames: $0 copay; Upgrades: $0 copay
Out-of-networkNot separately reported

Hearing

In-networkHearing Exams: $20 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-networkNot separately reported

Transportation

Not applicable
In-network10b(NMC): Not applicable
Out-of-networkNot separately reported

Fitness & wellness

In-networkFitness Benefit: $0 copay
Out-of-networkNot separately reported

Over-the-counter allowance

In-networkOver-the-Counter (OTC) Items: $0 copay
Out-of-networkNot separately reported

Meals

In-networkMeal Benefit: $0 copay
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · CMS reports a Part B premium reduction of $35 per month.

Maximum out-of-pocket (MOOP)

In-network$3,900
Combined in + outNo combined out-of-pocket maximum

Medical deductibles

In-network$0
Out-of-network$0

Annual health deductible

Not separately reported

Combined network deductible

$0

Part D premium

Not reported

Network & referrals

HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported

Prescription drugs0 tiers

Part D deductible

Not reported

Using this plan

Understand H3449-012-000

Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Blue Medicare Medical Only (HMO-POS) is a 2027 HMOPOS offered by Blue Cross and Blue Shield of North Carolina in Select North Carolina Counties. Referrals are required for some services. Its listed inpatient copay stages total $1,770 across 6 charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Primary Care Physician Services: $0 copay
Specialist
Physician Specialist Services: $25 copay
Laboratory services
Lab Services: $0–$25 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Diagnostic Procedures/Tests: $0–$25 copay
MRI, CT & PET imaging
Diagnostic Radiological Services: 20% coinsurance + $0–$300 copay
Outpatient hospital
Outpatient Hospital Services: $0–$275 copay; Observation Services: $0 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$150 copay
Listed inpatient stages
$1,770 total

6 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Part B premium reduction (“giveback”)

A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports a Part B premium reduction of $35 per month.

Availability

Who can enroll

Service area
Select North Carolina Counties (NC)
Plan type
HMOPOS
Contract / plan
H3449-012
Coverage year
2027

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalMedicare Dental Services: $25 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Prophylaxis (Cleaning): $0 copay; Fluoride Treatment: $0 copay; Restorative Services: $0 copay; Endodontics: $0 copay; Periodontics: $0 copay; Prosthodontics, removable: $0 copay; Oral and Maxillofacial Surgery: $0 copay; Adjunctive General Services: $0 copay
VisionEye Exams: $0–$25 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: $25 copay; Eyewear: 20% coinsurance; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: $0 copay; Eyeglass frames: $0 copay; Upgrades: $0 copay
HearingHearing Exams: $20 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $499–$999 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Over-the-counter allowanceOver-the-Counter (OTC) Items: $0 copay
Fitness & wellnessFitness Benefit: $0 copay
MealsMeal Benefit: $0 copay

Plan-specific answers

Frequently asked questions

Where is H3449-012-000 available?

Blue Medicare Medical Only (HMO-POS) is listed for Select North Carolina Counties (NC). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H3449-012-000?

The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $3,900. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H3449-012-000?

The listed Part C premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H3449-012-000?

The plan record lists $150 copay, waived when an admission meets the plan's stated timing rule.

Does H3449-012-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2027

Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H3449-012-000 fits

Full CMS plan ID
H3449-012-000
Contract
H3449
Base plan code
H3449-012
Segment
000
Carrier
Blue Cross and Blue Shield of North Carolina
Plan type
HMOPOS
Service area
Select North Carolina Counties (NC)

County/service-area foundation

CMS service-area entries

Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.

  • Alamance, NC
  • Alexander, NC
  • Alleghany, NC
  • Anson, NC
  • Ashe, NC
  • Avery, NC
  • Beaufort, NC
  • Bertie, NC
  • Bladen, NC
  • Brunswick, NC
  • Buncombe, NC
  • Burke, NC

88 additional service-area entries are retained in the data record.

Exact county navigation

These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.

Show 100 county links
North Carolina

Same CMS contract

H3449-023-001 Blue Medicare Essential Plus (HMO-POS) Essential Plus Region 1 · HMOPOS H3449-023-002 Blue Medicare Essential Plus (HMO-POS) Essential Plus Region 2 · HMOPOS H3449-023-004 Blue Medicare Essential Plus (HMO-POS) Essential Plus Region 4 · HMOPOS H3449-023-005 Blue Medicare Essential Plus (HMO-POS) Essential Plus Region 5 · HMOPOS H3449-024-001 Blue Medicare Enhanced (HMO-POS) Enhanced Region 1 · HMOPOS H3449-024-002 Blue Medicare Enhanced (HMO-POS) Enhanced Region 2 · HMOPOS H3449-024-003 Blue Medicare Enhanced (HMO-POS) Enhanced Region 3 · HMOPOS H3449-027-001 Blue Medicare Essential (HMO) Segment 1 · HMO

About this code

What H3449-012-000 identifies

H3449-012-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H3449-012, H3449 012, or the compact full CMS ID H3449012000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.