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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 2026, 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 2026.
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 $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 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) prescription drug plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or standard mail order. For Tier 3 preferred brand and Tier 4 non-preferred drugs, the plan requires a 25% coinsurance across all supply options. Tier 5 specialty medications also carry a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) offers comprehensive medical coverage featuring no copays for most services, though a 20% coinsurance applies to many outpatient, specialist, and emergency care visits. Inpatient hospital stays, skilled nursing facility care, and home health services are covered with no copay and no coinsurance. Additionally, diagnostic tests, medical equipment, and dialysis require no copay alongside a standard 20% coinsurance. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay and no coinsurance up to a $3,000 annual limit. Members also benefit from no copay and no coinsurance for up to 54 one-way transportation trips per year, a $1,950 hearing aid allowance every three years, and a $130 monthly allowance for over-the-counter items. Vision services are also available with no deductible, no copays, and a 20% coinsurance for routine exams.
Inpatient Hospital See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay, no coinsurance, and required prior authorization. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. The plan also covers up to 54 one-way transportation trips per year to any health-related location with no copay and no coinsurance.
Emergency Services See details
Emergency services are covered by CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) with a 20% coinsurance and no copay, up to a maximum of $115 per emergency visit and $40 per urgent care visit. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered under this plan.
Primary Care See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers primary care, specialist visits, telehealth, occupational, physical, and speech therapies, mental health, psychiatric, opioid treatment, and podiatry services with no copay and 20% coinsurance. Chiropractic services are not covered.
Preventive Services See details
Preventive services under CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) are partially covered, offering annual physical exams and select additional benefits with no copay and no coinsurance. While services like medical nutrition therapy and memory fitness are covered, several options including health education, in-home safety assessments, and weight management programs are not covered. Kidney disease education and other screenings require no copay but carry a 20% coinsurance.
Hearing Services See details
Hearing services covered by CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) include routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $1,950 every three years with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) offers partially covered vision services with no deductibles and no copays, featuring a 20% coinsurance for routine eye exams and contact lenses. Routine eye exams are limited to one per year and eyewear has a $150 annual limit, while other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 20% coinsurance, alongside other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $3,000 annual maximum. Sub-services that are not covered under this plan include other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, feature a coinsurance ranging from no coinsurance to 20%, with Part B insulin drugs also requiring a $35 copay.
Dialysis Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and brand or vendor limitations may apply to durable medical equipment and diabetic supplies.
Diagnostic and Radiological Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. Covered services include outpatient diagnostic procedures, lab services, x-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
The CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) plan covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copayment and no coinsurance, although prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
CareFirst BlueCross BlueShield Advantage DualPrime (HMO D-SNP) offers partial coverage for other services, featuring over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides a $130 monthly allowance that carries forward, and the meal benefit supports members who must remain at home due to a medical condition.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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