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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 2025, 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 2025.
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 $30.10. 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 Banner Medicare Advantage Dual (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Banner Medicare Advantage Dual (HMO D-SNP) plan provides coverage for a wide range of medical services. Many services, including primary care, outpatient services, and vision services, have a 20% coinsurance. The plan also covers home health services and diagnostic/radiological services with no copay or coinsurance. This plan also includes additional benefits such as hearing services with a maximum of $3300 per year for prescription hearing aids, and dental services with a 20% coinsurance. The plan offers an over-the-counter (OTC) benefit with a maximum of $200 every three months, along with transportation services with up to 36 one-way trips per year.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but details on copays are not provided. Additional days for Inpatient Hospital-Acute, 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 coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, while ambulatory surgical center services and outpatient substance abuse services have a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
The Banner Medicare Advantage Dual (HMO D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services to plan-approved health-related locations with up to 36 one-way trips per year, but transportation to any health-related location is not covered. There is no copay for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care services include coverage for primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services, physician specialist services, additional telehealth benefits, and podiatry services require prior authorization, and routine foot care has a limit of 6 visits per year and a 20% coinsurance. All other services have a 20% coinsurance.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Kidney disease education services require a doctor's referral and have a 20% coinsurance. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with a 20% coinsurance. Health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services with the Banner Medicare Advantage Dual (HMO D-SNP) plan include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a maximum benefit of $3300 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, has a 20% coinsurance, and a combined maximum of $200 per year. Eyeglasses (lenses and frames) are covered once per year, while eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan with a 20% coinsurance. Other dental services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, but not for maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs, Medicare Part B chemotherapy/radiation drugs, and other Medicare Part B drugs. Medicare Part B insulin drugs have a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered, and require a doctor's referral. You will pay 20% coinsurance 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, while DME for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan. All diagnostic services and all radiological services have no copay, but a coinsurance of at most 20% applies.
Home Health Services See details
Home Health Services are covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan, with no copay or 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 Banner Medicare Advantage Dual (HMO D-SNP) plan. The plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, and require prior authorization. The plan charges the Medicare-defined cost share for tier 1, but does not cover additional days beyond Medicare-covered, or non-Medicare-covered stays.
Other Services See details
The Banner Medicare Advantage Dual (HMO D-SNP) plan covers Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $200 every three months; it also covers a meal benefit that requires prior authorization. Acupuncture, 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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