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Medicare Blue Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare 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 Medicare Blue Dual (HMO D-SNP) in 2025, please refer to our full plan details page.
Medicare Blue Dual (HMO D-SNP) is a HMO D-SNP plan offered by Lifetime Healthcare, Inc. available for enrollment in 2025 to people living in Rochester and Central New York Area. The overall rating for this plan is not yet available for 2025.
It's important to know that Medicare 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:
Medicare 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 Medicare 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 Medicare Blue Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.90. 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 Medicare Blue Dual (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for standard generic drugs you will pay a $20 copay at a standard pharmacy and a $47 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you'll pay a monthly premium of $24.90.
Additional Benefits
The Medicare Blue Dual (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, while outpatient services, partial hospitalization, ambulance services, emergency services, and primary care have a 20% coinsurance. Preventive services are covered with no copay, while hearing, vision, dental, and medical equipment have coinsurance requirements. The plan also provides coverage for home health services with no copay, and skilled nursing facility stays with a copay after the initial 20 days. Additionally, this plan provides a monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $400 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $374 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric; however, additional days, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by the Medicare Blue Dual (HMO D-SNP) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by Medicare Blue Dual (HMO D-SNP) with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Medicare Blue Dual (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, 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 by the Medicare Blue Dual (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.
Primary Care See details
The Medicare Blue Dual (HMO D-SNP) plan covers primary care physician, chiropractic, occupational therapy, physician specialist, mental health specialty, other health care professional, psychiatric, physical therapy and speech-language pathology, additional telehealth, and opioid treatment program services. Primary care physician, chiropractic, physician specialist, and physical therapy and speech-language pathology services have a 20% coinsurance. Occupational therapy services, mental health specialty services, psychiatric services, and opioid treatment program services have a minimum and maximum coinsurance of 20%. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as annual physical exams. Other preventive services are covered, with a 20% coinsurance for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include routine hearing exams, with a coinsurance of at most 20% and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a 20% coinsurance. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $200 per year, with contact lenses and eyeglasses (lenses and frames) covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Medicare Blue Dual (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Other dental services include oral exams (1 every six months), dental x-rays, other diagnostic dental services, prophylaxis (cleaning) (1 every six months), fluoride treatment (1 every six months), other preventive dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare Blue Dual (HMO D-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies, and Diabetic Equipment, both with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medicare Blue Dual (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare Blue Dual (HMO D-SNP) plan, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is coinsurance for covered services, but no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Blue Dual (HMO D-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other services include a $75 monthly allowance for over-the-counter items, and a meal benefit for chronic illnesses, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. Nicotine Replacement Therapy is offered as a Part C OTC benefit.
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