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CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) in 2025, please refer to our full plan details page.
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) is a HMO D-SNP plan offered by CareFirst, Inc. available for enrollment in 2025 to people living in Maryland. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that CareFirst BlueCross BlueShield Advantage DualPrime (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:
CareFirst BlueCross BlueShield Advantage DualPrime (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 CareFirst BlueCross BlueShield Advantage DualPrime (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 CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.30. 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 $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 $8850.00 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 CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify for full LIS, your monthly premium for Part D will be $40.30. After your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan provides comprehensive coverage for a variety of healthcare needs. This plan covers inpatient and outpatient services, including mental health, with a 20% coinsurance for most services, and also covers ambulance services with a 20% coinsurance. Additional benefits include coverage for hearing, vision, and dental services, with varying copays and coinsurance. The plan also offers coverage for medical equipment, home health, and other services, with specific details on coinsurance and prior authorization requirements.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered under the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan. However, additional days, non-Medicare covered stays, and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital and Observation Services have a 20% coinsurance, while outpatient blood services have a 3-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this service.
Ambulance and Transportation Services See details
The CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and it also covers transportation services to any health-related location, with a limit of 36 one-way trips per year. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Chiropractic Services, Occupational Therapy Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services that require prior authorization. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20%, and routine hearing exams are covered once per year. Fitting/evaluation for hearing aids is covered with no deductible, up to 4 visits every three years, while prescription hearing aids (all types) are covered with a maximum benefit of $1,950 every three years, with 2 visits every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear, with a 20% coinsurance for eye exams and contact lenses. Eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan offers a combined maximum of $150.00 every year for eyewear.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. Orthodontic services have a maximum benefit of $3,000 per year, while Adjunctive General Services, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you'll pay a $35 copay plus 0-20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you'll pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan, but require prior authorization. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan. All diagnostic services and radiological services have no copay, and the coinsurance is at most 20%.
Home Health Services See details
Home Health Services are covered by the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan, but the specific services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. This plan has coinsurance for the covered services, but the specific amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the copay information can be found in the plan details.
Other Services See details
Other services include Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $130.00 every month, and Meal Benefit, which requires prior authorization. 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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