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Healthy Blue + Medicare (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Healthy Blue + Medicare (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Healthy Blue + Medicare (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Healthy Blue + Medicare (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Blue Cross and Blue Shield of North Carolina available for enrollment in 2025 to people living in Select North Carolina Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Healthy Blue + Medicare (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Healthy Blue + Medicare (HMO-POS 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 Healthy Blue + Medicare (HMO-POS 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 Healthy Blue + Medicare (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. 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 Healthy Blue + Medicare (HMO-POS D-SNP) plan has an enhanced alternative drug benefit. This plan has a deductible of $590.00. After the deductible is met, you will pay a 25% coinsurance for standard generic, preferred brand, and non-preferred drugs. For preferred generic drugs and specialty tier drugs, there is no copay. Once your total drug costs reach $2000.00, you enter the next coverage phase where you will pay nothing for your drugs.
Additional Benefits
The Healthy Blue + Medicare (HMO-POS D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services, such as emergency services, worldwide emergency services, home health services, vision eye exams, hearing exams, and dental services, have no copay. However, you may be responsible for a 20% coinsurance for outpatient services, primary care, preventive services, hearing services, vision services, dental services, and other services. This plan covers inpatient and outpatient hospital services, partial hospitalization, and ambulance services, with some services requiring prior authorization. Additionally, the plan includes coverage for hearing aids, vision eyewear, and dental services, with specific limits and cost-sharing arrangements. The plan also covers medical equipment, home infusion, and dialysis services, with varying cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. Additional days, non-Medicare-covered stays, and 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, including all outpatient hospital services, are covered under this plan with a 20% coinsurance. Outpatient Substance Abuse Services, Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered, with a 20% coinsurance for the latter, and coinsurance details for the former listed in the details section.
Partial Hospitalization See details
Partial Hospitalization is covered by the Healthy Blue + Medicare (HMO-POS D-SNP) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Healthy Blue + Medicare (HMO-POS D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Healthy Blue + Medicare (HMO-POS D-SNP) plan. Emergency Services have a $100 copay, while Urgently Needed Services have a $45 copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
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. For most services, you will pay 20% coinsurance, with the exception of routine chiropractic care, which is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, including additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies, which may have a copay. Other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay and a 20% coinsurance. Prescription hearing aids have no copay, and OTC hearing aids have no copay. The plan covers up to $3,000 per year for prescription hearing aids and up to $300 per year for OTC hearing aids.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and a $0 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, are covered, and have a 20% coinsurance for contact lenses, and a $0 copay for contact lenses, eyeglasses (lenses and frames), and eyeglass lenses; upgrades are not covered.
Dental Services See details
The Healthy Blue + Medicare (HMO-POS D-SNP) plan covers dental services, with a 20% coinsurance for Medicare Dental Services. Other dental services have no copay, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. Orthodontic services 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, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Healthy Blue + Medicare (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance, and Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services each have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Healthy Blue + Medicare (HMO-POS 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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay information is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
The Healthy Blue + Medicare (HMO-POS D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. However, 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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