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Blue Cross MA Dual Care Plus Preferred (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross MA Dual Care Plus Preferred (PPO 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 MA Dual Care Plus Preferred (PPO D-SNP) in 2026, please refer to our full plan details page.
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) is a PPO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in NM PPO DSNP. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Blue Cross MA Dual Care Plus Preferred (PPO 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 MA Dual Care Plus Preferred (PPO 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 MA Dual Care Plus Preferred (PPO 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 MA Dual Care Plus Preferred (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 MA Dual Care Plus Preferred (PPO D-SNP) plan features an annual prescription drug deductible of $615. Before the plan begins to cover the cost of your medications, you must pay this deductible amount out of pocket. Specific drug coverage tier details, such as copays and coinsurance for different medication levels, are currently not available for this plan. To determine how your personal prescriptions will be covered, it is best to review the plan's complete formulary or contact the plan provider directly.
Additional Benefits
The Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) plan offers comprehensive coverage where many core services, including primary care, outpatient services, and emergency care, feature no copay and a standard 20% coinsurance. Inpatient hospital stays, home health, and skilled nursing facility services are covered with no copay and no coinsurance, though prior authorization is required for most of these medical services. Preventive care, telehealth, and diagnostic lab tests are also fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits such as a $4,000 annual limit for dental care and a $2,000 annual allowance for prescription hearing aids with no copay and no coinsurance. Additionally, members benefit from up to 30 free one-way trips to health-related locations per year, a $250 annual eyewear allowance, and a $285 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance and Medicare-defined copayments, subject to prior authorization. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) with no copays, although a 20% coinsurance and prior authorization are required for outpatient hospital, ambulatory surgical center, outpatient blood, and outpatient substance abuse services. Outpatient observation services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 30 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) covers emergency services and urgently needed services with a 20% coinsurance (up to $110 and $40 per visit, respectively) and no copay, with costs not counting toward the plan deductible and waived upon hospital admission within three days. Worldwide emergency, urgent care, and emergency transportation services are not covered.
Primary Care See details
Primary care services under Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) are covered with no copay and a 20% coinsurance, including visits to primary care doctors, specialists, mental health professionals, and therapists. Telehealth and opioid treatment services are available with no copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) provides partial coverage for preventive services, offering covered benefits like kidney disease education, certain screenings, fitness benefits, and remote access technologies with no copay and no coinsurance. However, several services are not covered under this plan, including annual physical exams, health education, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) with no deductible, featuring one routine hearing exam per year with a 20% coinsurance and no copay, and fitting evaluations with no copay. Prescription hearing aids are covered up to $2,000 annually with no copay and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Blue Cross MA Dual Care Plus Preferred (PPO D-SNP), featuring one routine eye exam per year with no copay and a 20% coinsurance, while other eye exams are not covered. Eyewear is covered up to a $250 annual limit, offering contact lenses with no copay and 20% coinsurance, and eyeglass lenses and frames with no copay and no coinsurance, though upgrades and packaged eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by Blue Cross MA Dual Care Plus Preferred (PPO D-SNP), offering Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $4,000 annual limit. Sub-services not covered under this plan include fluoride treatments, implants, orthodontics, other diagnostic dental services, and other preventive dental services.
Home Infusion bundled Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs—including chemotherapy, radiation, and insulin—require between 0% (no coinsurance) and 20% coinsurance, with insulin drugs also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Blue Cross MA Dual Care Plus Preferred (PPO 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 covered services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) covers diagnostic and radiological services, subject to prior authorization. Outpatient diagnostic procedures, tests, and lab services are available with no copay and no coinsurance, while radiological services—including diagnostic, therapeutic, and X-ray services—carry no copay and a 20% coinsurance.
Home Health Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) plan because all key sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require a 20% coinsurance. Although the overall category technically lists no copay with prior authorization, these specific rehabilitation therapies are not covered.
Skilled Nursing Facility (SNF) See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) partially covers skilled nursing facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows for SNF admission without a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) partially covers other services, offering a meal benefit for chronic illness and up to $285 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture and Naloxone OTC coverage are not covered under this benefit.
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