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Samaritan Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Samaritan Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Samaritan Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Samaritan Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Samaritan Health Services available for enrollment in 2025 to people living in Benton, Linn and Lincoln counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Samaritan Dual Advantage (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:
Samaritan Dual Advantage (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 Samaritan Dual Advantage (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 Samaritan Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.10. 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 Samaritan Dual Advantage (HMO D-SNP) plan has a deductible of $590.00. After the deductible is met, you pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $26.10 for Part D. Once your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Samaritan Dual Advantage (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays are covered, and outpatient services, including substance abuse, have a 20% coinsurance, as do ambulance, emergency, and primary care services. The plan also covers hearing, vision, and dental services, with specific copays and maximum benefits. Additional benefits include home health services with no cost-sharing, and coverage for medical equipment and home infusion services with coinsurance. Other covered services include dialysis, diagnostic and radiological services, and acupuncture. However, some services like cardiac rehabilitation and certain transportation options are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but additional details about cost sharing are available elsewhere. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and 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, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance. Outpatient blood services have a 20% coinsurance and waive the three-pint deductible. Outpatient substance abuse services, ambulatory surgical center services, and other outpatient services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Samaritan Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Samaritan Dual Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to any health-related location are covered for up to 24 one-way trips per year, but transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Samaritan Dual Advantage (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Coverage has a $110 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Samaritan Dual Advantage (HMO D-SNP) plan covers primary care services with a 20% coinsurance, and chiropractic, occupational therapy, physician specialist, mental health specialty, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services with 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Samaritan Dual Advantage (HMO D-SNP) plan covers preventive services including annual physical exams, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, the 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, home-based palliative care, 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, and counseling services. The plan also covers personal emergency response systems and fitness benefits.
Hearing Services See details
Hearing services are covered by the Samaritan Dual Advantage (HMO D-SNP) plan, including hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids. Prescription Hearing Aids (all types) are covered, with a maximum benefit of $1,000 per year. OTC hearing aids are also covered up to $1,000 per year.
Vision Services See details
Vision services include eye exams with 20% coinsurance and routine eye exams with a $20 copay, and eyewear with a combined maximum benefit of $1,000 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services offer coverage for a variety of services, with a 20% coinsurance for Medicare Dental Services, and other services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered. However, Orthodontics is 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 with coinsurance between 0-20%, while other Medicare Part B drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Samaritan Dual Advantage (HMO D-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered by the Samaritan Dual Advantage (HMO D-SNP) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies and therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Lab Services are not covered. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by the Samaritan Dual Advantage (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 Samaritan Dual Advantage (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 additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The Samaritan Dual Advantage (HMO D-SNP) plan covers acupuncture with a $20 copay per visit, up to 30 treatments per year, and also covers over-the-counter (OTC) items with a maximum benefit of $132 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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