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iCircle Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for iCircle 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 iCircle Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
iCircle Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by CDS Monarch, Inc. available for enrollment in 2025 to people living in Finger Lakes, Southern Tier, Central, Western NY. The overall rating for this plan is not yet available for 2026.
It's important to know that iCircle 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:
iCircle 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 iCircle 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 iCircle Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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:
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Drug Coverage
The iCircle Dual Advantage (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered prescription medications before the plan begins to cover its share of the costs. Specific drug coverage tier details, including individual copayments and coinsurance rates, are not currently available for this plan. To determine your exact prescription costs and see if your medications are covered, you will need to review the plan's comprehensive formulary list.
Additional Benefits
The iCircle Dual Advantage (HMO D-SNP) plan offers robust coverage with no copays across almost all of its medical and supplemental benefits. Members can take advantage of inpatient hospital stays, skilled nursing facility care, home health services, and comprehensive dental care with no copay and no coinsurance. Additionally, the plan provides a monthly over-the-counter allowance of up to $265 with no copay or coinsurance. For outpatient services, doctor visits, diagnostic tests, and durable medical equipment, the plan features no copay but requires a 20% coinsurance. Emergency care and ambulance services also carry a 20% coinsurance and no copay, though emergency coinsurance is waived upon hospital admission. While hearing and vision services are partially covered with no copay or coinsurance, routine exams and devices like eyeglasses are not included.
Inpatient Hospital See details
Inpatient hospital services are partially covered by iCircle Dual Advantage (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays. Prior authorization is required, and the plan does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
Outpatient services under the iCircle Dual Advantage (HMO D-SNP) plan are covered with no copays, but are subject to a 20% coinsurance. This 20% coinsurance applies to outpatient hospital visits, ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services.
Partial Hospitalization See details
iCircle Dual Advantage (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance per year. Prior authorization may be required depending on the specific services received.
Ambulance and Transportation Services See details
iCircle Dual Advantage (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Emergency and urgently needed services are covered by iCircle Dual Advantage (HMO D-SNP) with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to a hospital within 72 hours. While worldwide emergency services are covered, worldwide emergency coverage, urgent coverage, and emergency transportation are not covered in practice.
Primary Care See details
Primary care and specialist services are covered under the iCircle Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance, which also applies to covered mental health, therapy, opioid treatment, and telehealth services. While routine chiropractic care is covered for up to 12 visits per year with no copay and 20% coinsurance, other chiropractic services and podiatry services are not covered.
Preventive Services See details
iCircle Dual Advantage (HMO D-SNP) partially covers preventive services, offering covered options like kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs with no copay and 20% coinsurance. Annual physical exams and additional preventive benefits—such as health education, fitness programs, in-home safety assessments, and personal emergency response systems—are not covered.
Hearing Services See details
iCircle Dual Advantage (HMO D-SNP) partially covers hearing exams with no copay and no coinsurance, but routine exams and fitting evaluations are not covered. For prescription hearing aids, some services are covered, but inner ear, outer ear, and over-the-ear types are not covered, and OTC hearing aids are also not covered.
Vision Services See details
iCircle Dual Advantage (HMO D-SNP) offers vision services with no copay and no coinsurance, meaning some services are covered, but routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
Dental services are covered by iCircle Dual Advantage (HMO D-SNP) with no copay and no coinsurance for both preventive and comprehensive care, including exams, cleanings, and orthodontic services. There is no maximum plan benefit limit, though prior authorization is required for restorative, endodontic, periodontic, and other complex treatments.
Home Infusion bundled Services See details
Home infusion bundled services are covered by iCircle Dual Advantage (HMO D-SNP) with no copay. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the iCircle Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by iCircle Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance across all categories, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment and prosthetic devices or medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the iCircle Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance for all services, including lab work, diagnostic procedures, therapeutic radiology, and outpatient X-rays. Prior authorization is required for all radiological services.
Home Health Services See details
Home Health Services are covered under the iCircle Dual Advantage (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the iCircle Dual Advantage (HMO D-SNP) plan with no copay, but only some services are covered as standard cardiac, intensive cardiac, pulmonary, 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
Skilled Nursing Facility (SNF) services are covered by iCircle Dual Advantage (HMO D-SNP) with no copay and no coinsurance, and do not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
iCircle Dual Advantage (HMO D-SNP) partially covers other services, offering over-the-counter items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $265 per month for over-the-counter items, and prior authorization is required for the meal benefit.
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* 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.
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