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CareSource Dual Advantage Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareSource Dual Advantage Plus (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 Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
CareSource Dual Advantage Plus (HMO D-SNP) is a HMO D-SNP plan offered by CareSource available for enrollment in 2026 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 Plus (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 Plus (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 Plus (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 Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.90. 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 CareSource Dual Advantage Plus (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, the plan offers savings with no copay for one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. This makes managing common health conditions highly affordable for plan members. For higher-tier medications, costs are structured around a percentage of the drug cost. Members pay a 25% coinsurance for Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs through standard pharmacies and standard mail order. This 25% coinsurance applies to one-, two-, and three-month supplies for Tiers 3 and 4, and one-month supplies for Tier 5.
Additional Benefits
The CareSource Dual Advantage Plus (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for key services, including inpatient hospital stays, home health care, and skilled nursing facility care. Beneficiaries also enjoy no copays and no coinsurance for select preventive services, chronic illness meals, over-the-counter items, and dental care up to a $4,000 annual limit. Additionally, there is no deductible for routine vision services under this plan. For many other medical services, such as primary care, specialist visits, outpatient hospital services, emergency care, and diagnostic tests, the plan features no copay alongside a 20% coinsurance. Medical equipment, dialysis, and ambulance services also require no copay and a 20% coinsurance. Notably, covered Part B insulin is an exception, requiring a $35 copay and up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by CareSource Dual Advantage Plus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CareSource Dual Advantage Plus (HMO D-SNP) outpatient services are covered with no copays, but a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by CareSource Dual Advantage Plus (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
CareSource Dual Advantage Plus (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered with no copay and no coinsurance. Unlimited one-way transportation is covered for plan-approved health-related locations, but transportation to any health-related location is not covered.
Emergency Services See details
CareSource Dual Advantage Plus (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within 3 days. Worldwide emergency, urgent, and 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 Plus (HMO D-SNP) covers primary care, specialist, outpatient therapy, mental health, telehealth, and opioid treatment services with no copay and 20% coinsurance. Routine podiatry is covered for up to six visits per year with no copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by CareSource Dual Advantage Plus (HMO D-SNP), offering annual physicals, fitness benefits, health education, PERS, and remote technologies with no copay and no coinsurance, alongside kidney education and select screenings with no copay and 20% coinsurance. Uncovered services include in-home safety assessments, 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, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by CareSource Dual Advantage Plus (HMO D-SNP), featuring no copay for exams and prescription hearing aids, though routine exams require a 20% coinsurance. While prescription hearing aids have no copay or coinsurance, OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
CareSource Dual Advantage Plus (HMO D-SNP) partially covers vision services with no copay, no deductible, and a 20% coinsurance for routine eye exams and contact lenses. Covered benefits include one routine eye exam per year and up to $500 annually for eyewear, while other eye exam services and upgrades are not covered.
Dental Services See details
Dental services are partially covered by CareSource Dual Advantage Plus (HMO D-SNP), with Medicare-covered dental requiring no copay and 20% coinsurance, and other covered dental services requiring no copay and no coinsurance up to a $4,000 annual limit. Sub-services that are not covered include other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
CareSource Dual Advantage Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the CareSource Dual Advantage Plus (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
CareSource Dual Advantage Plus (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
CareSource Dual Advantage Plus (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. While covered lab services have no coinsurance, other diagnostic procedures, outpatient X-rays, and radiological services require a 20% coinsurance.
Home Health Services See details
CareSource Dual Advantage Plus (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
CareSource Dual Advantage Plus (HMO D-SNP) does not cover cardiac rehabilitation services, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services. These services require a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by CareSource Dual Advantage Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
CareSource Dual Advantage Plus (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is not covered under these services.
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