A non-government entity
CareSource Dual Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareSource 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 CareSource Dual Advantage (HMO D-SNP) in 2026, please refer to our full plan details page.
CareSource Dual Advantage (HMO D-SNP) is a HMO D-SNP plan offered by CareSource available for enrollment in 2025 to people living in Select Counties in Georgia. The overall rating for this plan is not yet available for 2026.
It's important to know that CareSource 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:
CareSource 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 CareSource 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 CareSource Dual Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.30. 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:
Sign up for CareSource Dual Advantage (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The CareSource Dual Advantage (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share of your prescription costs. Detailed information regarding specific drug tiers, copayments, and coinsurance is currently unavailable for this plan. To determine how your specific medications are covered and what your exact costs will be under the $615 deductible, it is recommended to review the plan's comprehensive formulary.
Additional Benefits
The CareSource Dual Advantage (HMO D-SNP) plan offers comprehensive medical coverage with many essential services featuring no copays. Beneficiaries can access inpatient hospital stays, skilled nursing facility care, home health services, and unlimited plan-approved transportation with no copay and no coinsurance. For other major services like primary and specialist care, outpatient visits, emergency services, and medical equipment, members will pay no copay and a standard 20% coinsurance. Additionally, this plan provides robust supplemental benefits to help reduce your out-of-pocket expenses. Covered dental services feature no copay and no coinsurance up to a generous $4,000 annual limit, while vision benefits offer up to $500 for eyewear with no copay and a 20% coinsurance. Members also benefit from covered hearing aids, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
CareSource Dual Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CareSource Dual Advantage (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 also feature no copay and a 20% coinsurance, with no deductible for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization services are covered under the CareSource Dual Advantage (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
CareSource Dual Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
CareSource Dual Advantage (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within three days. Worldwide emergency, urgent care, and emergency transportation services are also covered with a 20% coinsurance and no copay, up to a maximum plan benefit of $10,000.
Primary Care See details
CareSource Dual Advantage (HMO D-SNP) covers primary care, specialist, mental health, telehealth, and therapy services with no copay and a 20% coinsurance. Chiropractic services are not covered under this plan, and select services like physical therapy and opioid treatment require prior authorization.
Preventive Services See details
CareSource Dual Advantage (HMO D-SNP) provides partially covered preventive services, offering annual physical exams and select benefits with no copay and no coinsurance, while kidney education and other screenings carry a 20% coinsurance and no copay. Several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
CareSource Dual Advantage (HMO D-SNP) covers hearing services with no copay and 20% coinsurance for annual routine hearing exams, alongside unlimited fitting evaluations at no cost. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by CareSource Dual Advantage (HMO D-SNP), offering one routine eye exam per year and annual eyewear coverage up to $500 with no copay, no deductible, and a 20% coinsurance. Covered eyewear options include contact lenses, eyeglass lenses, and frames, but other eye exam services and upgrades are not covered.
Dental Services See details
Dental services are partially covered by CareSource Dual Advantage (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $4,000 annual limit. Excluded services that are not covered under this plan include other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
CareSource Dual Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by CareSource Dual Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
CareSource Dual Advantage (HMO D-SNP) covers medical equipment, including 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
CareSource Dual Advantage (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays across all services. Lab services are covered with no coinsurance, while diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays carry a 20% coinsurance.
Home Health Services See details
Home health services are covered by CareSource Dual Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
CareSource Dual Advantage (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
CareSource Dual Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This plan does not require a prior three-day inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by CareSource Dual Advantage (HMO D-SNP), which features over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved