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Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in TX HMO DSNP. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that Blue Cross Medicare Advantage Dual Care Plus (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:
Blue Cross Medicare Advantage Dual Care Plus (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 Blue Cross Medicare Advantage Dual Care Plus (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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $9250.00 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 Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) prescription drug coverage includes an annual drug deductible of $615. You must meet this deductible before the plan begins to pay its share for your covered prescription medications. Specific drug tier details, including individual copayments and coinsurance rates for different medication categories, are not available for this plan. To determine your exact out-of-pocket costs for specific prescriptions, you should consult the plan's comprehensive formulary.
Additional Benefits
The Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) offers comprehensive medical coverage with many essential services requiring no copay. Major medical services like inpatient hospital stays, home health, and skilled nursing facility care are covered with no copay and no coinsurance, while outpatient services, emergency care, and specialist visits generally feature a 20% coinsurance with no copay. Preventive services, lab tests, and telehealth are also fully covered with no copay and no coinsurance. This plan also includes strong supplemental benefits, such as dental coverage up to a $4,000 annual limit and hearing aid coverage up to $2,000 with no copay. Additionally, members receive an annual eyewear allowance of $200, up to 24 one-way transportation trips per year, and a quarterly $105 over-the-counter item allowance with no copays. These additional benefits help reduce out-of-pocket costs for routine dental, vision, and wellness needs.
Inpatient Hospital See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance. Prior authorization and referrals are required, and additional days, non-Medicare-covered stays, and acute room upgrades are not covered.
Outpatient Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers outpatient services with no copays, featuring a 20% coinsurance for outpatient hospital, ambulatory surgical center, blood, and substance abuse services. Outpatient observation services are also covered with no copay and no coinsurance, though prior authorization and referrals may be required for many of these benefits.
Partial Hospitalization See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this care.
Ambulance and Transportation Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within three days. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers primary care, specialist visits, mental health, and therapy services with no copay and 20% coinsurance, while telehealth and opioid treatment require no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers Medicare-covered preventive services, kidney disease education, diabetes training, glaucoma screenings, digital rectal exams, and EKGs with no copay and no coinsurance. Additional preventive benefits are partially covered, including fitness and remote access technologies with no copay, but excluding annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), offering no deductible, no copay for fitting evaluations, and a 20% coinsurance with no copay for one annual routine exam. Up to two prescription hearing aids are covered each year with no copay and no coinsurance up to a $2,000 maximum, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered under Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), offering one annual routine eye exam with no copay, 20% coinsurance, and no deductible, though other eye exams are not covered. Eyewear is covered up to $200 annually with no deductible, featuring contact lenses with no copay and 20% coinsurance, and eyeglass lenses and frames with no copay and no coinsurance, while upgrades and bundled eyeglasses are not covered.
Dental Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) features partially covered dental services, offering Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $4,000 annual limit. Specific sub-services that are not covered under this plan include other diagnostic services, fluoride treatments, other preventive services, implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Medicare Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment is covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP), including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these covered items, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization and referrals are required. Diagnostic procedures, tests, and lab services have no coinsurance, while diagnostic radiological, therapeutic radiological, and outpatient X-ray services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers cardiac rehabilitation services with no copay and a 20% coinsurance. Covered services include intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), all of which require prior authorization and a referral.
Skilled Nursing Facility (SNF) See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization and referrals are required. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered, but members can be admitted with less than a three-day prior inpatient hospital stay.
Other Services See details
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) partially covers other services, with acupuncture not covered. Covered benefits include over-the-counter (OTC) items up to $105 every three months and meals for chronic illness, both offered with no copay and no coinsurance.
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