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Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) in 2025, please refer to our full plan details page.
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) is a HMO D-SNP plan offered by Troy Holdings, Inc. available for enrollment in 2025 to people living in Piedmont and Mountain Regions. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Troy Medicare for Dual-eligible Beneficiaries (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:
Troy Medicare for Dual-eligible Beneficiaries (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 Troy Medicare for Dual-eligible Beneficiaries (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 Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $8850.00 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 Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay 25% coinsurance for most drugs in the initial coverage phase. For those who qualify for the low-income subsidy, the monthly premium for Part D is $41.60. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, such as ambulance and home health, have no copay, while others, including outpatient, emergency, and primary care services, have a 20% coinsurance. The plan also covers hearing, vision, and dental services with copays and coinsurance, along with specific maximum benefit amounts for each.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. This plan requires prior authorization and has coinsurance, with details provided in the plan documents.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a minimum of 20% and a maximum of 20% coinsurance. Outpatient Blood Services have a 20% coinsurance, with the three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan. This benefit requires prior authorization and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 32 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan. For both emergency and urgently needed services, there is a 20% coinsurance, but no copay. Worldwide emergency services are not covered.
Primary Care See details
The Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy services have a 20% coinsurance. Occupational therapy services, individual and group mental health and psychiatric sessions, and opioid treatment program services have a coinsurance of 20%. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services requiring prior authorization, health education, re-admission prevention, fitness benefits, enhanced disease management, kidney disease education services, and other preventive services, all with varying coinsurance costs. In-home safety assessment, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, 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, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20%, with a maximum benefit of $825 every two years, and routine hearing exams and fitting/evaluation for hearing aids, both of which are unlimited. Prescription hearing aids (all types) are covered for 2 visits every two years, while prescription hearing aids for the inner, outer, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance and a maximum plan benefit coverage of $50 per year. Eyewear, including contact lenses, has a 20% coinsurance and a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum benefit of $3000 per year, and include oral exams (2 visits per year), dental x-rays (1 visit), prophylaxis (cleaning) (2 visits), and fluoride treatment (1 visit). Orthodontic Services are covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and requires authorization. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan. Diagnostic procedures, tests, and lab services have no copay, with a coinsurance of at most 20%, while diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services also have no copay, with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan. Specifically, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan, but additional days beyond Medicare-covered SNF 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
Other Services offered by the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan include Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $115.00 every month, but acupuncture, meal benefits, 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.
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