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Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in NM HMO DSNP. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Dual Care Plus (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:
Blue Cross Medicare Advantage Dual Care Plus (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 Blue Cross Medicare Advantage Dual Care Plus (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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $9250.00 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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) features a yearly prescription drug deductible of $615. Under this plan, you must pay this deductible amount out-of-pocket for your medications before your prescription drug coverage begins. Specific details regarding drug tiers, copayments, and coinsurance amounts are not currently available for this plan. To determine how your individual prescriptions are covered, you will need to review the plan's drug formulary or contact the provider.
Additional Benefits
The Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan offers robust medical coverage with no copays for most services, though a 20% coinsurance applies to outpatient care, emergency services, and specialist visits. Inpatient hospital stays, home health care, and skilled nursing facility services are covered with no copay and no coinsurance. Essential diagnostic tests and preventive care are also available at no cost to help you manage your health. This plan also features generous supplemental benefits, including dental coverage up to $4,000 annually with no copay or coinsurance for preventive and comprehensive care. You will also benefit from a $2,000 annual hearing aid allowance, a $250 vision eyewear limit, and up to 24 free one-way transportation trips to plan-approved locations. Additionally, the plan provides an over-the-counter allowance of $285 every three months with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay and no coinsurance, although referrals and prior authorization are required. This benefit is partially covered because upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) offers outpatient services with no copayments, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Medicare-covered observation services are covered with no copay and no coinsurance, and prior authorization or referrals may be required.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers partial hospitalization with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within three days. Although worldwide emergency services are technically covered, worldwide emergency coverage, urgent coverage, and emergency transportation are not covered.
Primary Care See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers primary care, specialist, and therapy services with no copay and a 20% coinsurance, while telehealth and opioid treatment are available with no copay and no coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered, and podiatry services are also not covered.
Preventive Services See details
Preventive services are partially covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copays and no coinsurance for covered benefits, including Medicare-covered preventive care, fitness programs, and kidney disease education. However, several options are not covered, such as annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) offers hearing services with no deductible, featuring one annual routine hearing exam with no copay and 20% coinsurance, alongside unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $2,000 annually with no copay and no coinsurance, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), offering one routine annual eye exam with no copay and a 20% coinsurance, while other eye exams are not covered. Eyewear benefits include contact lenses (no copay and 20% coinsurance), eyeglass lenses (no copay), and frames (no copay) up to a $250 annual limit with no deductible, though upgrades and complete eyeglasses are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) offers dental services with no copay and a 20% coinsurance for Medicare-covered dental care, and no copay or coinsurance for preventive and comprehensive services up to a $4,000 annual limit. While exams, cleanings, and restorative care are covered, fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance with no copay, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required for these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers diagnostic and radiological services, though prior authorization and referrals are required. Diagnostic procedures, tests, and lab services feature no copay and no coinsurance, while radiological services, including therapeutic and X-ray services, require a 20% coinsurance and no copay.
Home Health Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay and a 20% coinsurance. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered, allowing for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, though acupuncture is not covered. The OTC benefit provides up to $285 every three months that carries forward if unused, while the meal benefit requires a referral.
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