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Medicare Blue Dual Secure (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Blue Dual Secure (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 Secure (HMO D-SNP) in 2026, please refer to our full plan details page.
Medicare Blue Dual Secure (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 Secure (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 Secure (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 Secure (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 Secure (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.20. 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 Secure (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies filled at standard pharmacies or through standard mail order. For Tier 2 generic drugs, you will pay a copay of $20 per month, while Tier 3 preferred brand drugs require a $47 monthly copay. For higher-tier medications, Tier 4 non-preferred drugs and Tier 5 specialty tier drugs both require a 25% coinsurance for all supply durations. These standard pharmacy and standard mail-order rates help you easily calculate your out-of-pocket prescription costs. This cost-sharing structure makes the Medicare Blue Dual Secure (HMO D-SNP) a practical option for managing your medication expenses.
Additional Benefits
The Medicare Blue Dual Secure (HMO D-SNP) plan offers comprehensive medical coverage with a focus on low-cost options for inpatient and outpatient care. For inpatient hospital stays, members pay no coinsurance and a set copay for the first five days, followed by no copay for days six through 90. Most outpatient services, primary care visits, emergency care, and specialist consultations require no copay and a standard 20% coinsurance. This plan also features robust supplemental benefits with no deductibles, including preventive and comprehensive dental care with no copay and no coinsurance. Routine hearing and vision exams are covered with no copay and 20% coinsurance, alongside a $200 annual eyewear allowance and up to two hearing aids per year with no copay or coinsurance. Additionally, members benefit from home health services with no copay or coinsurance, as well as a $75 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Medicare Blue Dual Secure (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $400 copayment for days 1 through 5 of an acute stay and a $374 copayment for days 1 through 5 of a psychiatric stay, followed by no copay for days 6 through 90. Prior authorization is required, and these services are partially covered as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare Blue Dual Secure (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, while prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by Medicare Blue Dual Secure (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Medicare Blue Dual Secure (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services, urgently needed care, and worldwide emergency coverage are covered by Medicare Blue Dual Secure (HMO D-SNP) with no copays and a 20% coinsurance. The emergency services coinsurance is capped at $115 per visit and is waived if admitted to the hospital within 23 hours, while urgently needed services coinsurance is capped at $40.
Primary Care See details
Medicare Blue Dual Secure (HMO D-SNP) covers primary care, specialist, therapy, mental health, and psychiatric services with no copay and 20% coinsurance, while additional telehealth benefits feature no copay and no coinsurance. Podiatry services and routine chiropractic care are not covered, and physical therapy and speech-language pathology services require prior authorization.
Preventive Services See details
Preventive services are covered by Medicare Blue Dual Secure (HMO D-SNP) with no copay and no coinsurance for annual physicals and kidney disease education, though glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs require a 20% coinsurance and no copay. Additional preventive benefits are only partially covered; memory fitness and remote access technologies are covered, but health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Medicare Blue Dual Secure (HMO D-SNP) with no deductible, offering hearing exams with no copay and a 20% coinsurance for routine yearly exams. Prescription hearing aids are partially covered with no copay and no coinsurance for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Medicare Blue Dual Secure (HMO D-SNP) partially covers vision services with no deductibles, offering one routine eye exam per year and covered eyewear up to a $200 annual limit with no copays. Routine eye exams and contact lenses require a 20% coinsurance (with no coinsurance for eyeglasses), while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Medicare Blue Dual Secure (HMO D-SNP) covers Medicare-covered dental services with no copay and 20% coinsurance. Preventive and comprehensive dental services, including cleanings, exams, and orthodontic care, are covered with no copay and no coinsurance.
Home Infusion bundled Services See details
Medicare Blue Dual Secure (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Medicare Blue Dual Secure (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Blue Dual Secure (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 covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Medicare Blue Dual Secure (HMO D-SNP) partially covers diagnostic and radiological services with no copay and a 20% coinsurance, though prior authorization is required and lab services are not covered. Covered services under this benefit include diagnostic procedures, outpatient X-rays, and diagnostic or therapeutic radiological services.
Home Health Services See details
Medicare Blue Dual Secure (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Medicare Blue Dual Secure (HMO D-SNP) provides Cardiac Rehabilitation Services with no copay, though only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare Blue Dual Secure (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medicare Blue Dual Secure (HMO D-SNP) partially covers other services with no copay and no coinsurance, featuring a chronic illness meal benefit and a $75 monthly allowance for over-the-counter (OTC) items. Acupuncture is not covered under this plan.
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