Blue Shield TotalDual Plan (HMO D-SNP)

Blue Shield TotalDual Plan (HMO D-SNP) is a HMO D-SNP plan offered by California Physicians' Service available for enrollment in 2025 to people living in Los Angeles and San Diego Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Blue Shield TotalDual Plan (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Blue Shield TotalDual Plan (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.

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:

Drug Coverage

The Blue Shield TotalDual Plan (HMO D-SNP) offers an enhanced alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies, while Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs carry a 25% coinsurance. If you qualify for the low-income subsidy, your Part D premium can be reduced to $7.00. Once your out-of-pocket drug expenses reach $2,100.00, you transition into the catastrophic coverage phase. During this phase, you pay nothing for covered Medicare Part D prescription drugs. This plan provides a structured path to help manage and eventually eliminate your medication costs for the year.

Additional Benefits

The Blue Shield TotalDual Plan (HMO D-SNP) offers comprehensive healthcare coverage with no copays for the majority of outpatient, primary care, emergency, diagnostic, and medical equipment services. Most of these covered benefits require a 20% coinsurance, though standard preventive care is available with no copay or coinsurance. While inpatient hospital stays and skilled nursing facility services are covered with Medicare-defined costs, prior authorizations and doctor referrals are frequently required across many plan benefits. In addition to medical care, members benefit from specialized vision, hearing, and dental coverage, featuring no copays and coinsurance up to 20%. The plan provides valuable extras, including a $120 quarterly over-the-counter allowance, up to 48 one-way transportation trips per year, and allowances of $365 for eyewear and $1,500 for routine hearing services. However, certain services like cardiac rehabilitation and over-the-counter hearing aids are not covered under this plan.