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Memorial Hermann Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Memorial Hermann 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 Memorial Hermann Dual Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Memorial Hermann Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Memorial Hermann Health System available for enrollment in 2025 to people living in TX -Houston area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Memorial Hermann 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:
Memorial Hermann 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 Memorial Hermann 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 Memorial Hermann Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.70. 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 Memorial Hermann Dual Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly Part D premium will be $16.70. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Memorial Hermann Dual Advantage (HMO D-SNP) plan offers a range of benefits with cost-sharing through coinsurance, typically at 20% for many services. This includes coverage for inpatient and outpatient services, primary care, preventive, hearing, vision, and dental services. The plan also covers ambulance services with no copay, along with transportation to health-related locations. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services, all subject to coinsurance. The plan also offers coverage for home health services with no copay, and offers other services like over-the-counter items and meal benefits for chronic illnesses. However, some services like Cardiac Rehabilitation Services, Skilled Nursing Facility (SNF) and additional hours of care, and personal care services may have other cost-sharing requirements or are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with coinsurance costs following Original Medicare. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, individual and group sessions for outpatient substance abuse, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Memorial Hermann Dual Advantage (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
The Memorial Hermann Dual Advantage (HMO D-SNP) plan covers ambulance services with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation services to plan-approved health-related locations are also covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Memorial Hermann Dual Advantage (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum benefit coverage amount of $50,000.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a coinsurance of 20%. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. Kidney Disease Education Services have a 20% coinsurance, and other preventive services, including Glaucoma Screening and Diabetes Self-Management Training, also have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20%, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $1,000 every year. Prescription hearing aids (inner ear, outer ear, and over the ear) 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, eyeglass frames, and upgrades, also have a 20% coinsurance with a combined maximum benefit of $1000 per year.
Dental Services See details
The Memorial Hermann Dual Advantage (HMO D-SNP) plan covers dental services with a 20% coinsurance for Medicare dental services and a $4,000 maximum benefit per year for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered, but subject to visit limits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Memorial Hermann Dual Advantage (HMO D-SNP) plan. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, with no copay and requires authorization, while DME for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Memorial Hermann Dual Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Memorial Hermann Dual Advantage (HMO D-SNP) plan. While the plan covers some cardiac rehabilitation services, it does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization, with coinsurance costs that are not specified. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Memorial Hermann Dual Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $200 every three months, and meal benefits for chronic illnesses. 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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