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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 ALTCS 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) features a defined standard drug benefit with a yearly prescription drug deductible of $615.00. If you qualify for the low-income subsidy, also known as LIS or Extra Help, your Part D premium is reduced to $17.00. After meeting your deductible, you will pay cost-sharing drug costs during the initial coverage phase until total drug expenditures reach $2,100.00. Once your yearly out-of-pocket drug costs hit this $2,100.00 threshold, you enter the catastrophic coverage phase and enjoy no copay for all Medicare Part D covered drugs.
Additional Benefits
The Banner Medicare Advantage Dual (HMO D-SNP) plan provides comprehensive coverage where most outpatient services, primary care, specialist visits, emergency care, and medical equipment require a 20% coinsurance and no copay. Inpatient hospital stays and skilled nursing facility care are covered using Original Medicare-defined copays and coinsurance rates. Preventive care services, including annual physical exams, are available to members with no copay or coinsurance. For specialty care, members benefit from up to $4,000 annually for dental services, a $3,300 prescription hearing aid allowance, and a $200 annual eyewear allowance, all featuring no copay. Additionally, the plan includes a quarterly allowance of $350 for over-the-counter items and up to 36 annual one-way transportation trips to plan-approved locations with no copay or coinsurance. Routine hearing and vision exams are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Banner Medicare Advantage Dual (HMO D-SNP), requiring prior authorization and utilizing Original Medicare-defined copays and coinsurance. Under this plan, upgrades for acute care, additional days, and non-Medicare-covered stays for both acute and psychiatric hospitalizations are not covered.
Outpatient Services See details
Outpatient services are covered by Banner Medicare Advantage Dual (HMO D-SNP) with a 20% coinsurance and no copay. This coverage includes outpatient hospital visits, observation services, ambulatory surgical center services, outpatient substance abuse sessions, and blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Banner Medicare Advantage Dual (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Banner Medicare Advantage Dual (HMO D-SNP), as transportation to any health-related location is not covered. Ground and air ambulance services require a 20% coinsurance and no copay, while up to 36 annual one-way trips to plan-approved locations are available with no copay or coinsurance.
Emergency Services See details
Banner Medicare Advantage Dual (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, and the emergency coinsurance 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 are covered by Banner Medicare Advantage Dual (HMO D-SNP) and include doctor visits, specialist services, therapies, and chiropractic care. Patients will pay a 20% coinsurance and no copay for these covered services, with prior authorization required for select benefits.
Preventive Services See details
Banner Medicare Advantage Dual (HMO D-SNP) provides coverage for preventive services, including annual physical exams and zero-dollar Medicare-covered services with no copay or coinsurance. Kidney disease education and select screenings are covered with a 20% coinsurance and no copay, though additional benefits like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Banner Medicare Advantage Dual (HMO D-SNP) partially covers hearing services, offering routine exams and fitting evaluations once per year with no copay and a 20% coinsurance. While prescription hearing aids are covered up to a $3,300 annual limit, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Banner Medicare Advantage Dual (HMO D-SNP) partially covers vision services, offering covered benefits like one annual routine eye exam and contact lenses with no copay and a 20% coinsurance. Covered eyewear is subject to a $200 annual limit, while standalone 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 a 20% coinsurance and no copay for Medicare-covered care, and up to $4,000 annually with no copays or coinsurance for other dental services. While cleanings, exams, and restorative care are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Banner Medicare Advantage Dual (HMO D-SNP) covers home infusion bundled services with prior authorization, requiring no copay and ranging from no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Banner Medicare Advantage Dual (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic services. These covered benefits require prior authorization and are subject to a 20% coinsurance with no copay.
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. These services, which include diagnostic procedures, lab tests, therapeutic radiology, and outpatient X-rays, require prior authorization.
Home Health Services See details
Home Health Services are covered by Banner Medicare Advantage Dual (HMO D-SNP), though prior authorization is required to access these benefits. Specific copay and coinsurance details for this service are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Banner Medicare Advantage Dual (HMO D-SNP) plan. This non-coverage extends to all sub-services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Banner Medicare Advantage Dual (HMO D-SNP), with prior authorization required and Medicare-defined copay and coinsurance rates applying. While standard SNF services are covered, additional days beyond Medicare-covered care are not covered.
Other Services See details
Banner Medicare Advantage Dual (HMO D-SNP) partially covers Other Services, providing a maximum benefit of $350 every three months with no copay or coinsurance for over-the-counter (OTC) items. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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