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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 2025, 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 2025.
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 $19.80. 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 $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:
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Drug Coverage
The Healthy Blue Enhanced Care (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your prescriptions based on the drug tier and pharmacy you use. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium will be $19.80.
Additional Benefits
The Healthy Blue Enhanced Care (HMO D-SNP) plan offers a range of benefits with varying costs. Many services, such as primary care, preventive services, and home health, have no copay. Other services, like inpatient hospital stays, outpatient services, and emergency services, have copays ranging from $20 to $295. The plan also includes coverage for hearing, vision, and dental services. Hearing services include exams, and prescription hearing aids with a maximum benefit of $1500 per year. Vision services include eye exams and eyewear. Dental services include oral exams and cleaning.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-7, the copay is $295, and for days 8-90, there is no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Healthy Blue Enhanced Care (HMO D-SNP) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $250, and observation services with a $250 copay. Additionally, the plan covers ambulatory surgical center services and outpatient blood services with no copay, and outpatient substance abuse services with a $30 copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthy Blue Enhanced Care (HMO D-SNP) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $250 copay, and transportation services to plan-approved health-related locations with no copay for up to 36 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Healthy Blue Enhanced Care (HMO D-SNP) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a $20 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Healthy Blue Enhanced Care (HMO D-SNP) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay. Occupational therapy services have a $30 copay. Physician specialist services have a $30 copay, and physical therapy and speech-language pathology services have a $30 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, and opioid treatment program services have a $30 copay. Additional telehealth benefits have no copay. Podiatry services have a copay that ranges from $0 to $30, and other health care professional services have a copay that ranges from $0 to $20. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, including annual physical exams with no copay. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. However, services such as Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with no copay. Prescription hearing aids are partially covered, with a maximum benefit of $1500 per year, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
The Healthy Blue Enhanced Care (HMO D-SNP) plan covers vision services, including eye exams with a copay between $0 and $30, and eyewear with no copay, up to a combined maximum of $125 per year; however, upgrades are not covered. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses have no copay.
Dental Services See details
Dental services include oral exams and prophylaxis (cleaning) with no copay, but dental X-rays, fluoride treatments, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Medicare dental services require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay, and Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Healthy Blue Enhanced Care (HMO D-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered under the Healthy Blue Enhanced Care (HMO D-SNP) plan, with Durable Medical Equipment (DME) subject to 0-20% coinsurance and requiring prior authorization. Prosthetic Devices and Medical Supplies are covered, with Prosthetic Devices subject to 20% coinsurance and Medical Supplies subject to 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Lab Services. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $200, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Healthy Blue Enhanced Care (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Healthy Blue Enhanced Care (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include a meal benefit with no copay, and Medicare Community Resource Support with no copay, while acupuncture, over-the-counter items, 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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