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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 2026, 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 2026.
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 $49.30. 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 Medicare Blue Dual (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. Generic drugs in Tier 2 carry a $20 copay for a one-month supply, while Tier 3 preferred brand drugs require a $47 copay for a one-month supply. For higher-tier medications, Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance for standard pharmacy and mail order fills. Multi-month supplies of Tier 2 and Tier 3 drugs are also available, with copays reaching $60 for Tier 2 and $141 for Tier 3 on a three-month supply.
Additional Benefits
The Medicare Blue Dual (HMO D-SNP) plan offers comprehensive coverage with no copays for primary care, specialist, and outpatient services, though a standard 20% coinsurance typically applies. For inpatient hospital stays, members pay a daily copay for the first five days ($400 for acute and $374 for psychiatric) and no copay for days six through 90. Skilled nursing facility stays also feature no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100. This plan also provides strong everyday benefits, including home health services and preventive dental care with no copays or coinsurance. Vision and hearing exams require no copay alongside a 20% coinsurance, with the plan offering up to $200 annually for eyewear and coverage for up to two hearing aids. Additionally, members receive a $75 monthly over-the-counter allowance and a chronic illness meal benefit with no copay and no coinsurance.
Inpatient Hospital See details
Medicare Blue Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $400 daily copay for acute stays and a $374 daily copay for psychiatric stays for days 1 through 5, and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare Blue Dual (HMO D-SNP) covers outpatient services with no copays, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Medicare Blue Dual (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Medicare Blue Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Medicare Blue Dual (HMO D-SNP) with a 20% coinsurance and no copay, including emergency care capped at $115 per visit (waived if admitted within 23 hours) and urgent care capped at $40. Worldwide emergency, urgent, and transportation services are also covered with a 20% coinsurance and no copay.
Primary Care See details
Medicare Blue Dual (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive Services under Medicare Blue Dual (HMO D-SNP) are generally covered with no copay and no coinsurance, though additional benefits are only partially covered, excluding services like health education and in-home safety assessments. Covered benefits include annual physical exams and kidney disease education with no copay or coinsurance, while other services like glaucoma screenings and diabetes self-management training have no copay but require a 20% coinsurance.
Hearing Services See details
Hearing services are covered by Medicare Blue Dual (HMO D-SNP), featuring one routine hearing exam per year with no copay and a 20% coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Medicare Blue Dual (HMO D-SNP) offers partially covered vision services with no copays or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan covers one routine eye exam per year and provides up to $200 annually for eyeglasses and contact lenses, while other eye exams, separate eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by Medicare Blue Dual (HMO D-SNP) with no copay and no coinsurance for preventive and comprehensive care, including cleanings, x-rays, and orthodontic services. Medicare-covered dental services are also available with no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Medicare Blue Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Medicare Blue Dual (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Blue Dual (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Medicare Blue Dual (HMO D-SNP) partially covers diagnostic and radiological services, with prior authorization required. Covered services—including diagnostic procedures, radiological services, and outpatient X-rays—have no copay and a 20% coinsurance, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by Medicare Blue Dual (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Medicare Blue Dual (HMO D-SNP) covers some cardiac rehabilitation services with no copay, though standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Medicare Blue Dual (HMO D-SNP) provides partially covered skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medicare Blue Dual (HMO D-SNP) partially covers other services, providing a meal benefit for chronic illnesses and a $75 monthly over-the-counter allowance with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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