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Healthy Blue Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthy Blue Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthy Blue Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Healthy Blue Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select parishes in Louisiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Healthy Blue Dual Advantage (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Healthy Blue Dual Advantage (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Healthy Blue Dual Advantage (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Healthy Blue Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Healthy Blue Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. The plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly premium of $48.30.
Additional Benefits
The Healthy Blue Dual Advantage (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing options. Many services, such as routine hearing and eye exams, preventative services, and home health services, have no copay. The plan also provides coverage for emergency services, with a $90 copay, and outpatient services and primary care services with a coinsurance of 20%. Additional benefits include coverage for dental, hearing, and vision services, with specific copays and coinsurance depending on the service. The plan also covers ambulance services, partial hospitalization, and offers an over-the-counter allowance. Some services require prior authorization, and some services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and additional days, and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered. The plan's coinsurance for these services is defined by Medicare.
Outpatient Services See details
Outpatient services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a minimum 20% and maximum 20% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthy Blue Dual Advantage (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare plans, are covered. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Healthy Blue Dual Advantage (HMO D-SNP) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Services has a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Healthy Blue Dual Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance. Routine chiropractic care has no copay. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, as well as additional preventive services. Additional services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with no copay and at most 20% coinsurance, fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) with no copay, and up to $3,000 per year. Over-the-counter hearing aids are covered with no copay, with a maximum benefit of $300 per year (both ears combined). Prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have no copay. The plan covers a combined maximum of $500 per year for eyewear.
Dental Services See details
The Healthy Blue Dual Advantage (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a maximum benefit of $4,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Healthy Blue Dual Advantage (HMO D-SNP) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Healthy Blue Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
The Healthy Blue Dual Advantage (HMO D-SNP) plan covers Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, as well as Prosthetics/Medical Supplies with no copay and a 20% coinsurance for Medicare-covered services. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Healthy Blue Dual Advantage (HMO D-SNP) plan. For diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, you will pay a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Healthy Blue Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but specific services like Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and there is coinsurance for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the coinsurance is defined by Medicare.
Other Services See details
The Healthy Blue Dual Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $165.00 per month. The plan also provides a meal benefit with no copay for a chronic illness, and Medicare Community Resource Support with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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