A non-government entity
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 2026, 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 2026.
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 $4.80. 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 $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:
Sign up for Memorial Hermann 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 Memorial Hermann Dual Advantage (HMO D-SNP) plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your medications before your plan benefits begin to cover the costs. Detailed information regarding prescription drug tiers, copays, and coinsurance is currently unavailable for this plan. To find out how much your specific medications will cost under this plan, you should consult the official formulary or contact the provider directly.
Additional Benefits
The Memorial Hermann Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For most outpatient care, primary and specialist visits, emergency services, and diagnostic tests, members will pay no copay and a 20% coinsurance. Additionally, the plan provides unlimited one-way transportation to approved health locations with no copay and no coinsurance. Members also benefit from generous dental, vision, and hearing coverage, including up to $4,000 annually for select dental services and $500 for hearing aids with no copay and no coinsurance. Routine vision and hearing exams are available with no copay, though some routine services require a 20% coinsurance. Finally, the plan includes zero-dollar preventive care and an over-the-counter benefit providing up to $205 every three months with no copay and no coinsurance.
Inpatient Hospital See details
Memorial Hermann Dual Advantage (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 covered.
Outpatient Services See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copayments and a 20% coinsurance. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Memorial Hermann Dual Advantage (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, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Memorial Hermann Dual Advantage (HMO D-SNP) with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services and worldwide emergency, urgent, and transportation services are also covered with a 20% coinsurance and no copay, up to a maximum benefit of $50,000.
Primary Care See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers primary care, specialist, therapy, telehealth, psychiatric, and mental health services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers annual physical exams and zero-dollar preventive services with no copay and no coinsurance, though additional preventive services are only partially covered. Excluded services include health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, home safety devices, and counseling. Kidney disease education, glaucoma screenings, and diabetes self-management training are covered with no copay and 20% coinsurance.
Hearing Services See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers hearing exams with no copay, though routine hearing exams carry a 20% coinsurance. Prescription hearing aids are partially covered up to a $500 annual limit with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Memorial Hermann Dual Advantage (HMO D-SNP) partially covers vision services with no copays, though a 20% coinsurance applies to routine eye exams and contact lenses. While routine eye exams and eyewear are covered with a $500 annual maximum benefit, other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Memorial Hermann Dual Advantage (HMO D-SNP), featuring Medicare-covered dental services with no copay and a 20% coinsurance, and other dental services up to a $4,000 annual limit with no copay and no coinsurance. While many preventive and comprehensive services are covered, this plan does not cover other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers Home Infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, feature no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Memorial Hermann Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Memorial Hermann Dual Advantage (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Memorial Hermann Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance for outpatient diagnostic procedures, lab services, and X-rays. Prior authorization is required for all radiological services, which include diagnostic, therapeutic, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by Memorial Hermann Dual Advantage (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered in practice under the Memorial Hermann Dual Advantage (HMO D-SNP) plan. While there is no copay, specific services including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Memorial Hermann Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit does not require a three-day prior inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Memorial Hermann Dual Advantage (HMO D-SNP) plan, which offers a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered, but eligible members receive up to $205 every three months in reimbursement for covered OTC items.
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