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Healthy Blue Enhanced Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthy Blue Enhanced Care (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 Enhanced Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Healthy Blue Enhanced Care (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 2026.
It's important to know that Healthy Blue Enhanced Care (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 Enhanced Care (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 Enhanced Care (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 Enhanced Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.70. 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 $615.00 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 $6750.00 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:
Sign up for Healthy Blue Enhanced Care (HMO D-SNP)
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Drug Coverage
The Healthy Blue Enhanced Care (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, members enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This coverage with no copay applies to one-month, two-month, and three-month supplies of these medications. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, standard pharmacy and mail-order fills require a 25% coinsurance for all supply durations. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply. This straightforward cost structure helps beneficiaries easily estimate their out-of-pocket expenses for various medication tiers.
Additional Benefits
The Healthy Blue Enhanced Care (HMO D-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, telehealth, and preventive services. For inpatient hospital stays, members pay a $295 copay per day for the first seven days and no copay thereafter, while specialist visits and outpatient therapies require a $30 copay. Emergency services carry a $130 copay, and the plan includes up to 36 free one-way transportation trips to plan-approved locations. This plan features robust supplemental benefits, including no copays for routine dental care up to a $1,500 annual limit and routine vision exams with a $250 yearly eyewear allowance. Members also benefit from no copays on routine hearing exams and prescription hearing aids up to $1,500 annually, alongside fully covered diabetic supplies and over-the-counter items. Additionally, medical equipment and Medicare Part B drugs carry a 0% to 20% coinsurance with no deductibles.
Inpatient Hospital See details
Healthy Blue Enhanced Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 copay for days 1 through 7 and no copay for days 8 and beyond. Prior authorization is required, and some services such as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $250, while outpatient substance abuse individual and group sessions carry a $30 copay.
Partial Hospitalization See details
Healthy Blue Enhanced Care (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a $100,000 maximum plan benefit limit.
Primary Care See details
Healthy Blue Enhanced Care (HMO D-SNP) offers primary care physician and telehealth visits with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, mental health, and psychiatric services have a $30 copay and no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, though routine and other chiropractic care are not, and podiatry services range from a $0 to $30 copay with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Healthy Blue Enhanced Care (HMO D-SNP) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, glaucoma screenings, diabetes self-management training, PERS, fitness benefits, remote access technologies, and home safety devices. However, several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers hearing services with no deductibles, no coinsurance, and prior authorization required. Medicare-covered exams require a $30 copay, while routine exams, fittings, and over-the-counter (OTC) hearing aids—up to a $300 annual limit—have no copay. Prescription hearing aids are covered up to $1,500 annually with no copay, but are only partially covered as inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers vision services with no deductible and no coinsurance, offering no copay for one routine annual eye exam and eyewear like contacts and glasses up to a $250 yearly limit. Other eye exam services and eyewear upgrades are not covered, and prior authorization is required for some exams.
Dental Services See details
Healthy Blue Enhanced Care (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance, up to a $1,500 yearly maximum. Covered services include preventive care, fillings, and oral surgery, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Medicare Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Healthy Blue Enhanced Care (HMO D-SNP) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment and supplies are fully covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization, featuring lab services with no copay or coinsurance and diagnostic tests with a $0 to $50 copay and no coinsurance. Outpatient X-rays require a $50 copay plus coinsurance, diagnostic radiological services require a minimum $50 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Healthy Blue Enhanced Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Healthy Blue Enhanced Care (HMO D-SNP) with no coinsurance and prior authorization required, but in practice only some services are covered because cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Healthy Blue Enhanced Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Healthy Blue Enhanced Care (HMO D-SNP) partially covers other services, which include over-the-counter (OTC) items, chronic illness meal benefits, and Medicare community resource support with no copay and no coinsurance. Acupuncture is not covered under this plan.
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