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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 2026, 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 out of 5 stars in 2026.
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 $31.30. 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 Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at a standard pharmacy for one-month, two-month, or three-month supplies. Additionally, Tier 6 vaccines are covered with no copay for a one-month supply at standard pharmacies. For other prescription drug categories, including Tier 2 generics, Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan charges a 25% coinsurance at standard pharmacies. This 25% coinsurance rate applies to one-month, two-month, and three-month supplies across all of these tiers. This straightforward cost structure helps you easily plan for your out-of-pocket prescription expenses.
Additional Benefits
The Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) plan offers comprehensive medical coverage with no copay for most essential services, including inpatient hospital stays, primary care, and specialist visits. While many of these services require no copay, a standard 20% coinsurance applies to outpatient care, emergency services, and ambulance transport. Prior authorization is required for several key medical services, including inpatient stays and diagnostic testing. This plan also features robust supplemental benefits, including dental coverage up to a $3,000 annual maximum and an over-the-counter allowance of $115 per month with no copay or coinsurance. Additionally, beneficiaries receive no-copay vision and hearing benefits with generous limits, alongside up to 32 one-way transportation trips per year to plan-approved locations. Routine services under these benefits typically carry no copay, though certain specialized treatments may require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. This benefit does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 32 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Troy Medicare for Dual-eligible Beneficiaries (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. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits for the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) are partially covered, with chiropractic and podiatry services not covered. Most covered services, including primary care, specialist, therapy, and mental health visits, feature no copay and a 20% coinsurance, while telehealth benefits are offered with no copay and no coinsurance.
Preventive Services See details
Preventive Services under the Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) are covered with no copay and no coinsurance for annual physicals, though prior authorization is required for additional benefits. While health education, fitness, and in-home support are covered, several additional services like in-home safety assessments, medical nutrition therapy, and personal emergency response systems are not covered. Kidney disease education and other select screenings are covered with no copay and a 20% coinsurance.
Hearing Services See details
Hearing services are partially covered by Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) with no deductible, no copay for exams, and a 20% coinsurance for routine hearing exams. Covered prescription hearing aids have no copay and no coinsurance up to an $825 maximum benefit every two years, but OTC hearing aids, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) offers partially covered vision services with no deductibles and no copays for covered benefits. Routine eye exams are covered once annually with a 20% coinsurance up to a $50 limit, though other eye exam services are not covered. Covered eyewear options, including glasses and contacts, have a $200 annual limit with no copay, but contact lenses are subject to a 20% coinsurance.
Dental Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance up to a $3,000 annual maximum, though Medicare-covered dental services require a 20% coinsurance and no copay. Sub-services that are not covered under this plan include implants, orthodontics, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these covered items, and diabetic supplies are limited to specific manufacturers.
Diagnostic and Radiological Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Prior authorization is required for all radiological services, which include diagnostic, therapeutic, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay, though Medicare-defined coinsurance applies and prior authorization is required. A three-day inpatient hospital stay is required prior to admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) partially covers other services, offering Over-the-Counter (OTC) items with no copay and no coinsurance up to a $115 monthly reimbursement. Acupuncture and meal benefits are not covered under this plan.
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