A non-government entity
CareSource Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareSource Dual Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareSource Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
CareSource Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by CareSource available for enrollment in 2025 to people living in Select Counties in Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that CareSource Dual Advantage (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:
CareSource Dual Advantage (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 CareSource Dual Advantage (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 CareSource Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.30. 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 $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:
Sign up for CareSource Dual Advantage (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The CareSource Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the cost-sharing amounts for each drug tier. Once your total drug costs reach $2000, 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 CareSource Dual Advantage (HMO D-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with coinsurance costs for many services. The plan also includes coverage for emergency services, ambulance and transportation services, and primary care, with coinsurance for most primary care services. Additional benefits include coverage for preventive services, hearing, vision, and dental services, along with home infusion, dialysis, and medical equipment. This plan also covers home health services with no copay, and offers coverage for over-the-counter items and meal benefits for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. Both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric have coinsurance costs, as defined by Medicare.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, and outpatient blood services have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a minimum and maximum 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the CareSource Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the CareSource Dual Advantage (HMO D-SNP) plan with a 20% coinsurance. There is a maximum per visit amount of $110 for Emergency Services and $45 for Urgently Needed Services. Worldwide Emergency Services have a maximum benefit of $10,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Mental Health Specialty Services, Podiatry Services, and Opioid Treatment Program Services have a 20% coinsurance. Other Health Care Professional services have a 20% coinsurance and no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered, including services not usually covered by Medicare, like an annual physical exam. Kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with a 20% coinsurance. The plan does not cover 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, therapeutic massage, adult day health services, nutritional/dietary benefits, 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, or counseling services.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered for 2 visits every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, has a 20% coinsurance with a combined maximum benefit of $600 per year.
Dental Services See details
CareSource Dual Advantage (HMO D-SNP) covers dental services, with a 20% coinsurance for Medicare dental services, and an annual maximum of $6,000 for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment are covered with a limit on the number of visits. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the CareSource Dual Advantage (HMO D-SNP) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the CareSource Dual Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by CareSource Dual Advantage (HMO D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Equipment is covered, with 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered under the CareSource Dual Advantage (HMO D-SNP) plan. There is no copay for these services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and Lab Services have a coinsurance of at most 0%.
Home Health Services See details
Home Health Services are covered by the CareSource Dual Advantage (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 technically covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered, or non-Medicare-covered stays. You will pay the Medicare-defined cost share for tier 1, and prior authorization is required.
Other Services See details
The CareSource Dual Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $255.00 per month, and Nicotine Replacement Therapy (NRT) is offered as a Part C OTC benefit. Meal benefits are also covered for chronic illnesses, but acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved