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Primewell Dual Plus (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Primewell Dual Plus (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Primewell Dual Plus (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Primewell Dual Plus (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Louisiana Health Service & Indemnity Company available for enrollment in 2025 to people living in Northwest, Central, and South Arkansas. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Primewell Dual Plus (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Primewell Dual Plus (HMO-POS 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 Primewell Dual Plus (HMO-POS 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 Primewell Dual Plus (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.90. 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 Primewell Dual Plus (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your monthly Part D premium will be $20.90. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Primewell Dual Plus (HMO-POS D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as ambulance services, routine hearing exams, and dental services (including exams, x-rays, and cleanings), have no copay. However, many services, including outpatient services, emergency services, primary care, and vision services, typically have a 20% coinsurance. This plan also covers preventive services, including annual physical exams with no copay, hearing services (including hearing exams and hearing aids), and vision services (including eye exams and eyewear). Additionally, the plan provides coverage for home health services, dialysis services, and medical equipment, each with specific cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but the specific cost-sharing details are not provided. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services and observation services, both with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are covered with a coinsurance of 20% or more. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Primewell Dual Plus (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services, but a 20% coinsurance applies to both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 84 one-way trips per year, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Primewell Dual Plus (HMO-POS D-SNP) plan. Emergency Services have a 20% coinsurance, while Urgently Needed Services also have a 20% coinsurance, and both have no copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care includes coverage for primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Chiropractic services have a 20% coinsurance, but routine care is not covered. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a minimum and maximum coinsurance of 20%. Occupational Therapy Services have a 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
The Primewell Dual Plus (HMO-POS D-SNP) plan covers preventive services, including annual physical exams with no copay, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit with 20% coinsurance. This plan does not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services include Routine Hearing Exams, Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids, and OTC Hearing Aids. Routine Hearing Exams and Fitting/Evaluation for Hearing Aids have no copay and at most 20% coinsurance. Prescription Hearing Aids have no copay and are covered up to a plan-specified amount of $1500 every year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC Hearing Aids have no copay.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and the plan covers contact lenses with no copay, eyeglasses (lenses and frames) with no copay, eyeglass lenses with no copay, eyeglass frames with no copay, and upgrades with no copay.
Dental Services See details
The Primewell Dual Plus (HMO-POS D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments with no copay. Other covered dental services include restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery with no copay. This plan does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Primewell Dual Plus (HMO-POS D-SNP) plan. 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 Primewell Dual Plus (HMO-POS D-SNP) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, each with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Primewell Dual Plus (HMO-POS D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Primewell Dual Plus (HMO-POS D-SNP) plan. While the plan covers Cardiac Rehabilitation Services, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Primewell Dual Plus (HMO-POS D-SNP) plan, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
Under the Primewell Dual Plus (HMO-POS D-SNP) plan, acupuncture, meal benefits, 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. Over-the-counter (OTC) items are covered up to $110.00 per month.
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