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BCBSAZ Health Choice Pathway (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCBSAZ Health Choice Pathway (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BCBSAZ Health Choice Pathway (HMO D-SNP) in 2025, please refer to our full plan details page.
BCBSAZ Health Choice Pathway (HMO D-SNP) is a HMO D-SNP plan offered by Blue Cross Blue Shield of Arizona available for enrollment in 2025 to people living in Arizona: APA, CCN, GIL, MAR, MOH, NAV, PIN, YAV. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that BCBSAZ Health Choice Pathway (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:
BCBSAZ Health Choice Pathway (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 BCBSAZ Health Choice Pathway (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 BCBSAZ Health Choice Pathway (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 $8400.00 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 BCBSAZ Health Choice Pathway (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, your monthly premium for Part D will be $30.10.
Additional Benefits
The BCBSAZ Health Choice Pathway (HMO D-SNP) plan offers a variety of benefits with a focus on outpatient care. Many services, including primary care, emergency services, and vision and dental services, have a 20% coinsurance. You will also have access to hearing services with no copay and 20% coinsurance. This plan also includes coverage for a range of preventive services, such as routine hearing exams and home health services with no copay, as well as coverage for medical equipment, and home infusion services with coinsurance. Additionally, this plan provides coverage for acupuncture treatments and over-the-counter (OTC) items with monthly coverage.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days and non-Medicare-covered stays for both are not covered. Copays apply, and prior authorization is required.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance and three pints of blood have a deductible waived. Individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services, both with a 20% coinsurance and no copay. Transportation Services to a plan-approved health-related location is covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, are covered by the BCBSAZ Health Choice Pathway (HMO D-SNP) plan with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The BCBSAZ Health Choice Pathway (HMO D-SNP) plan covers 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. Many of these services require a 20% coinsurance.
Preventive Services See details
The BCBSAZ Health Choice Pathway (HMO D-SNP) plan covers preventive services, including Medicare-covered zero-dollar preventive services, annual physical exams, and additional preventive services with prior authorization. The plan also covers therapeutic massage with 6 sessions per year, Personal Emergency Response Systems, In-Home Support Services, support for caregivers, fitness benefits, Remote Access Technologies, Home and Bathroom Safety Devices, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, this plan does not cover Health Education, In-Home Safety Assessments, Medical Nutrition Therapy, Post-discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay and 20% coinsurance. Prescription hearing aids are covered up to $1500 per year, and all types of prescription hearing aids have no copay and 20% coinsurance; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and routine eye exams once per year. Eyewear is covered with a 20% coinsurance, and has a combined maximum benefit of $350 per year for contact lenses, eyeglasses, and frames; eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BCBSAZ Health Choice Pathway (HMO D-SNP) plan covers dental services, including Medicare Dental Services with 20% coinsurance, oral exams (2 per year), dental x-rays (2 per year), prophylaxis (cleaning) (2 per year), and fluoride treatments (1 per year). Orthodontic services are covered up to a maximum of $3,500 per year, while adjunctive general services, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BCBSAZ Health Choice Pathway (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, is covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services has no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BCBSAZ Health Choice Pathway (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BCBSAZ Health Choice Pathway (HMO D-SNP) plan. Although Cardiac Rehabilitation Services are generally covered, this plan does not cover any of the associated sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but this plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the copay is based on the Medicare-defined cost share for tier 1.
Other Services See details
The BCBSAZ Health Choice Pathway (HMO D-SNP) plan covers acupuncture with a limit of 12 treatments per year, and also covers over-the-counter (OTC) items with a maximum benefit coverage amount of $125.00 per month. The plan also covers a meal benefit, but requires prior authorization. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and other services are not covered.
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