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Healthy Blue Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthy Blue 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 Healthy Blue Dual (HMO D-SNP) in 2025, please refer to our full plan details page.
Healthy Blue Dual (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Select counties in Missouri. The overall rating for this plan is not yet available for 2025.
It's important to know that Healthy Blue 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:
Healthy Blue 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 Healthy Blue 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 Healthy Blue Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.80. 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 Healthy Blue Dual (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you'll pay $25.80 for Part D. During the initial coverage phase, after you pay the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Healthy Blue Dual (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. You'll find no copays for many services, such as outpatient blood services, additional telehealth benefits, prescription hearing aids, and many dental services. This plan also provides coverage for emergency services, primary care, preventive services, hearing, vision, and dental care. Additionally, the plan includes coverage for home health services, medical equipment, and diagnostic services, and also covers some transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Healthy Blue Dual (HMO D-SNP) plan, but additional days, non-Medicare covered stays, and upgrades are not covered. Both acute and psychiatric care require prior authorization and have a coinsurance, with the specific amount determined by Medicare guidelines.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered, but the coinsurance is not specified. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthy Blue Dual (HMO D-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Healthy Blue Dual (HMO D-SNP), with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, and up to 210 one-way trips per year are included, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $90 copay, Urgently Needed Services have a $20 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Healthy Blue Dual (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. Primary care, chiropractic, physician specialist, and other health care professional services have a 20% coinsurance. Mental health individual and group sessions also have a 20% coinsurance. Podiatry services have a 20% coinsurance, and routine foot care is covered. Physical therapy and speech-language pathology services have a 20% coinsurance. Additional telehealth benefits have no copay. Opioid treatment program services have a 20% coinsurance. Note that routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services including Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have a 20% coinsurance. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss, 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
The Healthy Blue Dual (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay, and OTC hearing aids are covered with no copay and a maximum benefit of $3,000 per year.
Vision Services See details
The Healthy Blue Dual (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and routine eye exams with no copay. Eyewear is covered, with a 20% coinsurance and a combined maximum benefit of $500 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, a maximum benefit of $4,000 per year for Other Dental Services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. All services require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Healthy Blue Dual (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. 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 Healthy Blue Dual (HMO D-SNP) plan. 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 coinsurance between 0% and 20% and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance, both with no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. There is no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Healthy Blue 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 Healthy Blue Dual (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. You will pay the Medicare-defined cost share for tier 1, and the plan does not cover additional days beyond Medicare-covered SNF or non-Medicare-covered stays.
Other Services See details
Other Services with the Healthy Blue Dual (HMO D-SNP) plan include Over-the-Counter (OTC) Items with no copay, and a $160 maximum plan benefit. Other services, such as 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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