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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 2025, 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 2025.
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 $44.00. 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 Secure (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $20 copay for preferred generic drugs at a standard pharmacy. For preferred brand drugs, you will pay 35% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medicare Blue Dual Secure (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay for the first few days, and then no copay. Outpatient services, including doctor visits, have a coinsurance of 20%. This plan also covers ambulance services with a coinsurance, and emergency services with a 20% coinsurance. Preventative services and dental services are covered with a coinsurance. Hearing and vision services, including exams and some eyewear, are covered with a coinsurance.
Inpatient Hospital See details
The Inpatient Hospital benefit covers Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $400 copay for days 1-5, and no copay for days 6-90; additional days, non-Medicare-covered stays, and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $374 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a coinsurance of 20%. Outpatient Blood Services include three (3) pints deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Blue Dual Secure (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare Blue Dual Secure (HMO D-SNP) plan. All Ambulance Services are covered with no copay, but with a 20% coinsurance for both ground and air ambulance services. 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. Emergency Services and Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a 20% coinsurance.
Primary Care See details
The Medicare Blue Dual Secure (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Occupational therapy, individual and group mental health and psychiatric sessions, and opioid treatment program services have a minimum and maximum coinsurance of 20%. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The Medicare Blue Dual Secure (HMO D-SNP) plan covers preventive services, including annual physical exams and kidney disease education services. Some services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visits, have a 20% coinsurance. However, services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with 20% coinsurance, and for eyewear, also with 20% coinsurance and a combined maximum of $200 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Medicare Blue Dual Secure (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Blue Dual Secure (HMO D-SNP) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment (DME) has a 20% coinsurance, and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Supplies have a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered under the Medicare Blue Dual Secure (HMO D-SNP) plan with no copay, but a coinsurance of at most 20% applies for Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Medicare Blue Dual Secure (HMO D-SNP) plan with no copay or 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 not covered by the Medicare Blue Dual Secure (HMO D-SNP) plan. This includes 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 by the Medicare Blue Dual Secure (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $75.00 per month, as well as a Meal Benefit for chronic illness; however, 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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