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Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dual Care 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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in OK HMO DSNP. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Dual Care 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:
Blue Cross Medicare Advantage Dual Care 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 Blue Cross Medicare Advantage Dual Care 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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $5.00. 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 $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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) prescription drug coverage features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before your plan benefits kick in. Detailed drug tier information, including specific copayments and coinsurance rates, is not available for this plan. To understand how your specific medications are covered, it is recommended to check the plan's formulary directly.
Additional Benefits
The Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) offers comprehensive healthcare coverage with no copays for inpatient hospital stays, home health, and skilled nursing facility care. Many outpatient medical services, including primary care, specialist visits, emergency care, and diagnostic imaging, are covered with no copay and a 20% coinsurance. Additionally, the plan features no copays or coinsurance for preventive services, telehealth, and laboratory tests. Beneficiaries also receive robust supplemental benefits, including up to $4,000 annually for preventive and comprehensive dental care with no copay and no coinsurance. The plan covers routine hearing exams and prescription hearing aids up to $2,000 with no copay or coinsurance, alongside a $250 annual eyewear allowance and up to 24 free one-way transportation trips. Members also benefit from a $275 quarterly over-the-counter allowance and a chronic illness meal program with no copayments.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Medicare-covered observation services are available with no copay and no coinsurance, and prior authorization or referrals are required for most services.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services, which is waived if you are admitted. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while rides to any health-related location are not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers emergency services with a 20% coinsurance and no copay (up to $115 per visit), and urgently needed services with a 20% coinsurance and no copay (up to $40 per visit), with coinsurance waived if admitted to the hospital within 3 days. Worldwide emergency, urgent care, and emergency transportation services are not covered.
Primary Care See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Telehealth and opioid treatment services are covered with no copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay and no coinsurance for covered benefits, including fitness programs, remote access technologies, kidney disease education, and select screenings. Sub-services that are not covered include annual physical exams, health education, in-home safety assessments, personal emergency response systems, 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, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no plan deductible. Routine exams are covered once yearly with a 20% coinsurance and no copay, while fitting evaluations and prescription hearing aids (up to $2,000 annually) have no copay or coinsurance. However, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers vision services, offering one routine eye exam per year with no copay and a 20% coinsurance, while other eye exams are not covered. Covered eyewear features a $250 annual limit with no copay for lenses, frames, and contact lenses, though contact lenses carry a 20% coinsurance and upgrades or packaged eyeglasses are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and preventive and comprehensive dental services with no copay and no coinsurance up to a $4,000 yearly maximum. Under this plan, fluoride treatments, other diagnostic or preventive dental services, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from 0% (no coinsurance) to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers 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
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers diagnostic and radiological services with prior authorization and referrals required. Diagnostic procedures, tests, and lab services have no copay and no coinsurance, while diagnostic radiological services, therapeutic radiology, and outpatient X-rays carry no copay and a 20% coinsurance.
Home Health Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay, though some services are covered but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance. Prior authorization and referrals are also required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay and no coinsurance, requiring both prior authorization and a referral. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, though the plan uniquely allows for admission without a prior three-day inpatient hospital stay.
Other Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers other services with no copay and no coinsurance, including a chronic illness meal benefit with a referral and a $275 quarterly over-the-counter allowance. Acupuncture, Naloxone, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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