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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 2026, 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, Inc. 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 2026.
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 $10.50. 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 Samaritan Dual Advantage (HMO D-SNP) plan features an annual drug deductible of $615. For prescription drugs in Tiers 1 through 4, which cover generic and brand name medications, you will pay a 25% coinsurance for 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 5 specialty drugs also carry a 25% coinsurance for a 1-month supply at standard pharmacies. In contrast, Tier 6 select care drugs are highly affordable and feature no copay for 1-month and 3-month supplies at standard pharmacies or via standard mail order. Evaluating these coinsurance and deductible costs is an essential step in finding the right Medicare Advantage prescription drug coverage for your budget.
Additional Benefits
The Samaritan Dual Advantage (HMO D-SNP) plan offers comprehensive coverage for essential medical needs, featuring no copays and no coinsurance for inpatient hospital stays and home health services. For most outpatient care, primary care visits, emergency services, and medical equipment, members will pay no copay and a 20% coinsurance. Prior authorization is required for several key services, including inpatient admissions, outpatient hospital visits, and diagnostic procedures. This plan also includes valuable supplemental benefits, providing no copays and no coinsurance for dental care, eyewear, and hearing aids up to a $1,000 annual limit per category. Routine vision exams require a $20 copay and 20% coinsurance, while acupuncture is covered with a $20 copay and no coinsurance for up to 30 treatments. However, it is important to note that routine transportation, over-the-counter items, and meal benefits are not covered under this plan.
Inpatient Hospital See details
Samaritan Dual Advantage (HMO D-SNP) partially covers inpatient hospital services with no copay and no coinsurance, although prior authorization is required. While acute and psychiatric inpatient stays are covered, additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Samaritan Dual Advantage (HMO D-SNP) covers outpatient services with no copays, but a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for ambulatory surgical center and outpatient hospital services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Samaritan Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Samaritan Dual Advantage (HMO D-SNP) covers Medicare-covered ground and air ambulance services with a 20% coinsurance and no copay, which is not waived if you are admitted to the hospital. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Samaritan Dual Advantage (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the emergency coinsurance waived if you are admitted to the hospital within 24 hours. Worldwide emergency services are partially covered with a $115 copay and no coinsurance, though worldwide urgent care and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under Samaritan Dual Advantage (HMO D-SNP) are partially covered, with most services—including primary care, specialists, therapy, and mental health—requiring no copay and a 20% coinsurance. Podiatry services are not covered, routine and other chiropractic services are not covered, and additional telehealth benefits are covered with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Samaritan Dual Advantage (HMO D-SNP) with no copay and no coinsurance for covered benefits such as annual physicals, kidney disease education, fitness programs, and personal emergency response systems. However, the plan does not cover sub-services including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home modifications, and counseling.
Hearing Services See details
Samaritan Dual Advantage (HMO D-SNP) hearing services are partially covered, featuring diagnostic hearing exams with no copay, though routine exams and fitting/evaluations are not covered. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to a $1,000 annual limit, though inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
Samaritan Dual Advantage (HMO D-SNP) offers partially covered vision services, including one routine eye exam per year for a $20 copay and 20% coinsurance, while other eye exams are not covered. Covered eyewear, including contacts, lenses, frames, and upgrades, has no copay and no coinsurance up to a $1,000 annual maximum.
Dental Services See details
Samaritan Dual Advantage (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $1,000 yearly maximum, though orthodontics are not covered.
Home Infusion bundled Services See details
Samaritan Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, insulin, and other drugs require coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Samaritan Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Samaritan Dual Advantage (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Samaritan Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes outpatient diagnostic procedures, lab tests, diagnostic and therapeutic radiological services, and X-rays.
Home Health Services See details
Home health services are covered by Samaritan Dual Advantage (HMO D-SNP) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Samaritan Dual Advantage (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Samaritan Dual Advantage (HMO D-SNP) with no coinsurance and Medicare-defined copays, though prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Samaritan Dual Advantage (HMO D-SNP) provides partial coverage for other services, offering acupuncture with a $20 copay and no coinsurance for up to 30 treatments per year. Over-the-counter (OTC) items, meal benefits, and other additional services are not covered under this plan.
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