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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.
Key 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:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for True Blue Special Needs Plan (HMO D-SNP)
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Drug Coverage
The True Blue Special Needs Plan (HMO D-SNP) has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium is $54.70. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The True Blue Special Needs Plan (HMO D-SNP) offers a variety of benefits with varying cost-sharing. Hospital stays have a copay for the first 10 days, with no copay after that. Many services, including emergency care, home health, and hearing exams, have no copay, while others, such as outpatient services, primary care, and vision services, have coinsurance between 0% and 30%. Additional benefits include coverage for ambulance and transportation services, though with coinsurance or benefit limits. The plan also provides coverage for home infusion, dialysis, and medical equipment, all with some cost-sharing. Dental services are partially covered. The plan also offers an over-the-counter benefit and a meal benefit, with some limitations.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $250 copay for days 1-10 and no copay for days 11-90; additional days, non-Medicare-covered stays, and upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $220 copay for days 1-10 and no copay for days 11-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services and Observation Services with a 30% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance between 30% and 30%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the True Blue Special Needs Plan (HMO D-SNP), but requires prior authorization. You will pay 30% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services. Ground and air ambulance services have a 30% coinsurance. Transportation services to a plan-approved health-related location are covered, with a maximum plan benefit coverage amount of $300 every three months. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Emergency Services, Urgently Needed Services, and Worldwide Emergency Services, are covered. There is no copay for Emergency Services, but there is a 30% coinsurance for Urgently Needed Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with a 0% to 30% coinsurance, Chiropractic Services with a 30% coinsurance (excluding routine care), Occupational Therapy Services with 30% coinsurance, Physician Specialist Services with a 0% to 30% coinsurance, Mental Health Specialty Services with 30% coinsurance for individual and group sessions, Podiatry Services with 30% coinsurance for routine foot care (6 visits per year), Other Health Care Professional services with a 0% to 30% coinsurance, Psychiatric Services with 30% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 30% coinsurance, Additional Telehealth Benefits with a 0% to 30% coinsurance, and Opioid Treatment Program Services with 30% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, Health Education, Fitness Benefit (Memory Fitness), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 30% coinsurance, while In-Home Safety Assessment, Personal Emergency Response System (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 services are covered, including hearing exams and prescription hearing aids. Routine hearing exams have no copay and a 30% coinsurance, while fitting/evaluation for hearing aids and prescription hearing aids have no copay.
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, and contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by the True Blue Special Needs Plan (HMO D-SNP), with a 30% coinsurance for Medicare Dental Services. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), 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, with prior authorization 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 under the True Blue Special Needs Plan (HMO D-SNP), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is covered and includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, each with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the True Blue Special Needs Plan (HMO D-SNP). 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%; all services have no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but 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). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional and non-Medicare-covered days are not. Prior authorization is required, and coinsurance details are available in the plan documents.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, Meal Benefit, Other 1, and additional services. 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. OTC items are covered with a maximum benefit of $300 every three months. The Meal Benefit requires a doctor's referral. Other 1 requires prior authorization and covers Convenience Care with a maximum amount of $2500 every year.
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