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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 ALTCS 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, at which point you will enter the next coverage phase. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", you will pay $30.10 for Part D.
Additional Benefits
The Banner Medicare Advantage Dual (HMO D-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with a 20% coinsurance for many services. The plan covers primary care, preventive services, hearing, vision, dental, and home infusion services, with varying cost-sharing requirements. Prescription hearing aids are covered up to a maximum of $3300 per year, and other dental services have a maximum plan benefit of $4,000 every year. This plan also includes coverage for ambulance services, emergency services, and medical equipment, with a 20% coinsurance for most services. Additionally, the plan offers coverage for dialysis services and home health services. There is also coverage for over-the-counter items, with a maximum benefit of $270 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered; however, additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered. The copay for these services is not specified in the provided information.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, while ASC and outpatient substance abuse services have a minimum and maximum 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.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan, which includes coverage for ground and air ambulance services with a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 36 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan. Emergency Services have a 20% coinsurance, and Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a 20% coinsurance, Chiropractic Services with a 20% coinsurance, Occupational Therapy Services with a 20% coinsurance, Physician Specialist Services with a 20% coinsurance, Mental Health Specialty Services with a 20% coinsurance, Podiatry Services with a 20% coinsurance, Other Health Care Professional with a 20% coinsurance, Psychiatric Services with a 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with a 20% coinsurance, Additional Telehealth Benefits with a 20% coinsurance, and Opioid Treatment Program Services with a 20% coinsurance. Routine Chiropractic Care is limited to 6 visits per year.
Preventive Services See details
Preventive Services, including Medicare-covered services, Annual Physical Exams, and Remote Access Technologies, are covered by Banner Medicare Advantage Dual (HMO D-SNP). Kidney Disease Education Services require a doctor referral and have a 20% coinsurance. Other preventive services, including Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, also have a 20% coinsurance. Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include Routine Hearing Exams with a 20% coinsurance, and Fitting/Evaluation for Hearing Aids, each covered once per year. Prescription hearing aids are covered up to a maximum of $3300 per year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear, with a 20% coinsurance for eye exams and eyewear such as contact lenses. Eyeglasses (lenses and frames) are covered, limited to one pair every year. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum plan benefit of $4,000 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan. There is a 20% coinsurance, and a doctor referral is required.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices, and Medical Supplies each have a 20% coinsurance with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts each have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. All services have no copay, but require coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Banner Medicare Advantage Dual (HMO D-SNP) plan with no copay and no 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 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, but the plan does not provide additional days beyond Medicare-covered SNF or non-Medicare-covered SNF stays. Prior authorization is required, and you will have to pay the Medicare-defined cost share.
Other Services See details
Other Services with the Banner Medicare Advantage Dual (HMO D-SNP) plan cover Over-the-Counter (OTC) items, with a maximum benefit of $270 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, Meal Benefit, 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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