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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 2026, 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 2026.
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 $13.30. 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 $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 Healthy Blue Dual (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) prescriptions filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies. For Tier 2 (Generic), Tier 3 (Preferred Brand), and Tier 4 (Non-Preferred Drug) prescriptions, you will pay a 25% coinsurance for all supply durations. Tier 5 (Specialty Tier) medications also carry a 25% coinsurance, which is limited to a one-month supply. These cost-sharing rates apply to both standard retail pharmacy pickups and standard mail-order services.
Additional Benefits
The Healthy Blue Dual (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for several key services, though some care requires a 20 percent coinsurance. Inpatient hospital stays, home health, and skilled nursing facility services are fully covered with no copay or coinsurance. Outpatient services, primary care visits, and diagnostic tests also have no copay but carry a 20 percent coinsurance, while emergency care requires a 115 dollar copay with no coinsurance. Supplemental benefits include preventive and comprehensive dental care with no copay or coinsurance up to a 4,000 dollar annual limit. Vision and hearing benefits feature no copays, with generous allowances for eyeglasses and hearing aids alongside no-cost routine fitting evaluations. Additionally, members receive up to 210 free one-way transportation trips per year to plan-approved locations and a 160 dollar monthly allowance for over-the-counter items.
Inpatient Hospital See details
Healthy Blue Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not included.
Outpatient Services See details
Outpatient services are covered by Healthy Blue Dual (HMO D-SNP) with no copays for all services, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Healthy Blue Dual (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Healthy Blue Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 210 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Healthy Blue Dual (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $20 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a $100,000 maximum plan benefit limit.
Primary Care See details
Healthy Blue Dual (HMO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and a 20% coinsurance, while chiropractic services are not covered. Additional telehealth benefits are also available with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Healthy Blue Dual (HMO D-SNP), offering no copay and no coinsurance for annual physicals, kidney education, and fitness benefits, while glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs require a 20% coinsurance and no copay. Sub-services that are not covered include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, and counseling.
Hearing Services See details
Healthy Blue Dual (HMO D-SNP) hearing services are partially covered, featuring routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids (excluding inner ear, outer ear, and over-the-ear types) and over-the-counter hearing aids are covered with no copay or coinsurance, up to annual limits of $3,000 and $300 respectively.
Vision Services See details
Vision services are partially covered by Healthy Blue Dual (HMO D-SNP), excluding other eye exams and upgrades. Covered routine eye exams (one per year) and contact lenses feature no copay and 20% coinsurance, while eyeglasses have no copay and no coinsurance up to a $500 annual limit with no deductibles.
Dental Services See details
Healthy Blue Dual (HMO D-SNP) offers partially covered dental services up to a $4,000 annual limit, with no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and most comprehensive treatments. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Healthy Blue Dual (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Healthy Blue Dual (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Healthy Blue Dual (HMO D-SNP) with no copays across all categories, though coinsurance and authorization requirements vary. Durable medical equipment requires prior authorization and carries no copay with 0% to 20% coinsurance, while prosthetics and medical supplies require prior authorization with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are fully covered with no copay and no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Healthy Blue Dual (HMO D-SNP) covers diagnostic and radiological services, including diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Home health services are covered under the Healthy Blue Dual (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Healthy Blue Dual (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Healthy Blue Dual (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While a prior three-day inpatient hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Healthy Blue Dual (HMO D-SNP) partially covers other services with no copay and no coinsurance, including Medicare Community Resource Support, chronic illness meal benefits, and a $160 monthly over-the-counter (OTC) item allowance. Acupuncture is not covered under this benefit.
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