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True Blue Special Needs Plan (HMO D-SNP)

Benefits Summary and Overview

This page is a benefits summary and overview of key plan information for True Blue Special Needs Plan (HMO D-SNP). The information on this page is a summary only.

For a complete listing of all available benefits and cost information on True Blue Special Needs Plan (HMO D-SNP) in 2025, please refer to our full plan details page.

True Blue Special Needs Plan (HMO D-SNP) is a HMO D-SNP plan offered by Gemstone Holdings, Inc. available for enrollment in 2025 to people living in Select Counties in Idaho. The overall rating for this plan is not yet available for 2025.

It's important to know that True Blue Special Needs Plan (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:

True Blue Special Needs Plan (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.

Overview IconKey Plan Facts

Below are a few key facts and commonly-asked questions about True Blue Special Needs Plan (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 True Blue Special Needs Plan (HMO D-SNP), the main costs are as follows:

Monthly Premium

The Monthly Premium for this plan is $54.70. 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 $8400.00 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:

Regular visits to your primary care doctor are covered and will have a copay of $0 (no copay) and coinsurance of 0% - 30%.

Specialist Visits:

Visits to specialists are covered and will have a copay of $0 (no copay) and coinsurance of 0% - 30%. Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $0 (no copay) and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $0 (no copay) and coinsurance of 30%. Coverage may vary for in-network and out-of-network hospitals.

Sign up for True Blue Special Needs Plan (HMO D-SNP)

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Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

Drug Coverage IconDrug Coverage

The True Blue Special Needs Plan (HMO D-SNP) has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with the monthly premium costing $54.70 with LIS.

Additional Benefits IconAdditional Benefits

The True Blue Special Needs Plan (HMO D-SNP) offers a range of benefits, including coverage for inpatient hospital stays with a copay, and outpatient services and partial hospitalization with a 30% coinsurance. Emergency and primary care services are covered, with some services having no copay and others with a coinsurance. The plan also provides coverage for ambulance services, preventive, hearing, vision, dental, and home infusion services. Additional benefits include coverage for dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facilities. The plan also offers over-the-counter items, meal benefits with a doctor's referral, and "Other 1" services with prior authorization. However, some services like cardiac rehabilitation, and certain types of vision and dental services are not covered.

Inpatient Hospital See details

Inpatient Hospital benefits are covered, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-10, and no copay for days 11-90. For Inpatient Hospital Psychiatric, you will pay a $220 copay for days 1-10, and no copay for days 11-90. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 30% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a 30% coinsurance. Outpatient Blood Services are not covered.

Partial Hospitalization See details

Partial Hospitalization is covered under the True Blue Special Needs Plan (HMO D-SNP) with prior authorization required. You will pay 30% coinsurance for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, including ground and air ambulance services, with a 30% coinsurance. Transportation Services to a plan-approved health-related location are covered, with a maximum benefit coverage amount of $300 every three months, and transportation to any other health-related location is not covered.

Emergency Services See details

Emergency Services are covered with no copay and no coinsurance. Urgently Needed Services have a 30% coinsurance and no copay, while Worldwide Emergency Services have a 30% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.

Primary Care See details

Primary Care benefits include coverage for 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. Primary Care Physician Services and Physician Specialist Services have a coinsurance of 0% to 30%, while Chiropractic Services, Occupational Therapy Services, Individual and Group Sessions for Mental Health and Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services have a 30% coinsurance. Podiatry Services have a 30% coinsurance for Routine Foot Care. Other Health Care Professional services have a coinsurance of 0% to 30%. Additional Telehealth Benefits have a coinsurance of 0% to 30%. Routine Chiropractic Care is not covered.

Preventive Services See details

The True Blue Special Needs Plan (HMO D-SNP) covers preventive services, including annual physical exams, health education, fitness benefits (Memory Fitness), remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney Disease Education Services has a 30% coinsurance. In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 exams are covered, with a coinsurance of up to 30% for routine hearing exams, and no copay for routine hearing exams. Prescription hearing aids are partially covered, with no copay for prescription hearing aids (all types), but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.

Vision Services See details

Vision services include eye exams with a 30% coinsurance, and routine eye exams with no copay. Eyewear is covered with a 30% coinsurance, with a combined maximum of $200 per year for contact lenses. Eyeglasses (lenses and frames) and upgrades are also covered, while eyeglass lenses and frames are not covered.

Dental Services See details

Dental Services are partially covered, with a 30% coinsurance for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. 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 by the True Blue Special Needs Plan (HMO D-SNP), with a coinsurance between 20% and 20%.

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 Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance, with no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 30%, while Diagnostic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 30%, and Therapeutic Radiological Services have a coinsurance of at most 20%.

Home Health Services See details

Home Health Services are covered by the True Blue Special Needs Plan (HMO D-SNP) with no copay or 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 True Blue Special Needs Plan (HMO D-SNP). Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the True Blue Special Needs Plan (HMO D-SNP). Prior authorization is required, but the plan does not specify the cost sharing for these services.

Other Services See details

The True Blue Special Needs Plan (HMO D-SNP) covers Over-the-Counter (OTC) items up to $300 every three months, including nicotine replacement therapy and Naloxone. 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. Meal Benefits are covered with a doctor referral, and "Other 1" services are covered with prior authorization up to a maximum of $2500 per year.

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