Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)

Inpatient Hospital See details

Inpatient Hospital benefits, including acute and psychiatric care, are covered and require prior authorization and a doctor's referral, with the cost share defined by Medicare. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered, nor are upgrades for inpatient hospital-acute.

Outpatient Services See details

Outpatient Services include outpatient hospital services with a 20% coinsurance, observation services with no coinsurance, ambulatory surgical center (ASC) services with 20% coinsurance, and outpatient substance abuse services with a 20% coinsurance for both individual and group sessions. Outpatient blood services are not covered.

Partial Hospitalization See details

Partial Hospitalization is covered, but requires prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services, including ground and air ambulance, are covered. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. 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 by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services are not covered.

Primary Care See details

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 are covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. You will pay 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Individual and Group Sessions for Mental Health and Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Other Health Care Professional services. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.

Preventive Services See details

Preventive services are covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. The plan covers Medicare-covered preventive services, with no copay.

Additional preventive services and kidney disease education services are covered with no copay, as are glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits.

Hearing Services See details

Hearing exams are covered by the plan, with a coinsurance of at most 20% for routine hearing exams and no copay. Prescription hearing aids (all types) are covered with no copay and a maximum benefit of $2,000 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.

Vision Services See details

Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and a $0 copay for other exams, while eyewear has a 20% coinsurance for contact lenses and a $0 copay for eyeglass lenses, eyeglass frames, and upgrades; however, eyeglasses (lenses and frames) are not covered.

Dental Services See details

Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, and cleaning have no copay, but fluoride treatment, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.

Medical Equipment See details

Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. For DME, there is a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance and no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic Radiological Services, 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 Blue Cross Medicare Advantage Dual Care Plus (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 by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan, but the cost sharing information is not provided. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits. Over-the-Counter (OTC) Items have no copay and a maximum plan benefit coverage amount of $338 every three months, and Meal Benefits also have no copay. However, acupuncture, 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.