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Banner Medicare Advantage Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Banner Medicare Advantage Dual (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Banner Medicare Advantage Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Banner Medicare Advantage Dual (HMO D-SNP) is a HMO D-SNP plan offered by Banner Health available for enrollment in 2025 to people living in ACC Central and Southern AZ Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Banner Medicare Advantage Dual (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:
Banner Medicare Advantage Dual (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 Banner Medicare Advantage Dual (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 Banner Medicare Advantage Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.00. 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 $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 Banner Medicare Advantage Dual (HMO D-SNP) offers a defined standard drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay cost-sharing amounts during the initial coverage phase until total drug costs reach $2,100.00. Additionally, individuals who qualify for the Low-Income Subsidy (LIS) can see their Part D premium reduced to $17.00. Once your yearly out-of-pocket drug expenses reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs. You may still be responsible for a share of the costs for excluded drugs covered under enhanced benefits. It is recommended to review the plan's formulary to verify coverage for your specific medications.
Additional Benefits
The Banner Medicare Advantage Dual (HMO D-SNP) offers comprehensive healthcare coverage, featuring no copay and a 20% coinsurance for primary care visits, outpatient services, emergency care, and diagnostic testing. Standard preventive services and annual physicals are covered with no copay and no coinsurance, while inpatient hospital stays follow Original Medicare-defined cost-sharing. Additionally, dialysis and durable medical equipment are covered with no copay and a 20% coinsurance. For supplemental care, the plan provides robust dental benefits up to a $4,000 annual maximum and prescription hearing aids up to $3,300 annually with no copay or coinsurance. Vision services require no copay and a 20% coinsurance, which includes a $200 annual limit for eyewear. Members also receive up to 36 one-way transportation trips per year to approved locations and a $215 quarterly allowance for over-the-counter items with no copays or coinsurance.
Inpatient Hospital See details
Banner Medicare Advantage Dual (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services, with copays and coinsurance determined by Original Medicare-defined cost sharing. Prior authorization is required, and the plan does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services are covered by Banner Medicare Advantage Dual (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Banner Medicare Advantage Dual (HMO D-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Banner Medicare Advantage Dual (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 36 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Banner Medicare Advantage Dual (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered under this plan.
Primary Care See details
Banner Medicare Advantage Dual (HMO D-SNP) covers primary care and related healthcare services with no copay and a 20% coinsurance. These covered benefits include primary care physician visits, specialist care, physical therapy, and mental health services, though prior authorization is required for some services.
Preventive Services See details
Banner Medicare Advantage Dual (HMO D-SNP) covers standard Medicare preventive services and annual physical exams with no copay and no coinsurance. Additional preventive services are partially covered, including memory fitness and remote access technologies, but excluding services like health education, weight management, and in-home safety assessments. Kidney disease education and specific screenings, such as glaucoma and diabetes self-management training, require a 20% coinsurance and no copay.
Hearing Services See details
Banner Medicare Advantage Dual (HMO D-SNP) partially covers hearing services, including routine hearing exams and fitting evaluations with a 20% coinsurance and no copay. Prescription hearing aids are covered up to $3,300 annually with no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Banner Medicare Advantage Dual (HMO D-SNP) offers partially covered vision services with no copay and a 20% coinsurance, including routine eye exams and a $200 annual limit for eyewear. Covered services include annual exams, contact lenses, and eyeglasses (lenses and frames), while individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Banner Medicare Advantage Dual (HMO D-SNP) offers partially covered dental services with an annual maximum benefit of $4,000, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a 20% coinsurance and no copay, while other covered services include oral exams, cleanings, x-rays, fluoride, and restorative care.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Banner Medicare Advantage Dual (HMO D-SNP) with prior authorization required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan with 20% coinsurance and no copay.
Medical Equipment See details
Medical equipment benefits, including durable medical equipment, prosthetics, and diabetic supplies, are covered by Banner Medicare Advantage Dual (HMO D-SNP) with no copay and 20% coinsurance. Prior authorization is required for these services.
Diagnostic and Radiological Services See details
Banner Medicare Advantage Dual (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance. Prior authorization is required for these services, which include diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan, though prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan, as none of the sub-services, including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, are covered. Because these services are not covered, there are no copayments or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Banner Medicare Advantage Dual (HMO D-SNP), requiring prior authorization and no prior three-day hospital stay, though additional days beyond Medicare-covered limits are not covered. Copay and coinsurance costs for these services follow Medicare-defined cost-sharing.
Other Services See details
Banner Medicare Advantage Dual (HMO D-SNP) partially covers other services, offering a meal benefit for chronic illnesses and a $215 quarterly allowance for over-the-counter items with no copays or coinsurance. Acupuncture and highly integrated services for dual-eligible SNPs are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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