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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 2025, 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 Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $49.80. 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 $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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the specified costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you'll pay $49.80 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with some services requiring a copay or coinsurance. Emergency, primary care, and preventive services are covered, with some services having no copay. Additional benefits include coverage for hearing and vision services, with some cost-sharing, as well as dental services with 20% coinsurance. You'll also find coverage for ambulance and transportation services, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility services. This plan also offers no copay for OTC items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with a copay (see plan details). Additional days for Inpatient Hospital-Acute, Non-Medicare-covered stays for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with 20% coinsurance, and observation services with no coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a minimum and maximum coinsurance of 20% for individual and group sessions, and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are offered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and a 20% coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
The Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, 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 services, mental health specialty services, psychiatric services, and other health care professional services have a minimum coinsurance of 20%. Additional telehealth benefits have no copay, and opioid treatment program services have no coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan, including Medicare-covered preventive services, with no copay, as well as services like Fitness Benefit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) which may have a copay. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams and no copay for fitting/evaluation for hearing aids, while prescription hearing aids (all types) have no copay, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and no copay; eyewear has a 20% coinsurance, with contact lenses, eyeglass lenses, eyeglass frames, and upgrades having no copay, while eyeglasses (lenses and frames) are not covered.
Dental Services See details
The Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, and prophylaxis (cleaning) have no copay, with 2 oral exams, 1 dental x-ray, and 2 cleanings covered per year. Orthodontic services are covered up to a maximum of $4,000 per year, while fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0% and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. For DME, there is a 20% coinsurance, and for Prosthetics, Medical Supplies, and Diabetic Supplies, there is a 20% coinsurance, with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. There is no copay for any of these services. Diagnostic Procedures/Tests and Lab Services have no coinsurance, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) plan. Prior authorization and a doctor referral are required for these services, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but this plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor referral are required, and the cost sharing is the Medicare-defined cost share for tier 1.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, with no copay for either. 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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