Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)

3 out of 5 stars
$10.80
Monthly Premium

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation

Plan ID: H9706-002

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.


Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) - H9706-002 by Health Care Service Corporation as well as other Medicare Advantage plans available in your area.

$10.80
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $9350
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $2000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Coinsurance for Primary Care Office Visit $0% or$ 20%
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Coinsurance for Physician Specialist Office Visit $0% or$ 20%
Prior Authorization Required for Doctor Specialty Visit
Referral Required for Doctor Specialty Visit
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $0
Deductible $1340.00
Prior Authorization Required for Acute Hospital Services
Referral Required for Acute Hospital Services
Urgent Care

Urgent Care:
Coinsurance for Urgent Care 0% or 20%
Coinsurance for Medicare Covered Urgent Care waived if you are admitted to hospital
Emergency Room Visit

Emergency Care:
Coinsurance for Emergency Care 0% or 20%
Ambulance Transportation
In-Network:

Ground Ambulance:
Coinsurance for Ground Ambulance Services $0% or$ 20%

Air Ambulance:
Coinsurance for Air Ambulance Services $0% or$ 20%
Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:

Chiropractic Services:
Coinsurance for Medicare-covered Chiropractic Services 0% or 20%
Prior Authorization Required for Chiropractic Services
Referral Required for Chiropractic Services
Only chiropractic services, related to the subuxation of the spine require authorization.
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:

Diabetic Supplies and Services:
Coinsurance for Medicare-covered Diabetic Supplies 0% or 20%
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 0% or 20%
Durable Medical Equipment (DME)
In-Network:

Durable Medical Equipment:
Coinsurance for Medicare-covered Durable Medical Equipment 0% or 20%
Prior Authorization Required for Durable Medical Equipment
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0
Copayment for Medicare-covered Lab Services $0
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
Referral Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Coinsurance for Medicare-covered Diagnostic Radiological Services 0% or 20%
Coinsurance for Medicare-covered Therapeutic Radiological Services 0% or 20%
Coinsurance for Medicare-covered X-Ray Services 0% or 20%
Home Health Care
In-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Referral Required for Home Health Services
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0
Prior Authorization Required for Psychiatric Hospital Services
Referral Required for Psychiatric Hospital Services
Mental Health Outpatient Care
In-Network:

Outpatient Mental Health Services:
Coinsurance for Medicare-covered Individual Sessions 0% or 20%
Coinsurance for Medicare-covered Group Sessions 0% or 20%
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 0% or 20%
Prior Authorization Required for Outpatient Hospital Services
Referral Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $0
Referral Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Coinsurance for Ambulatory Surgical Center Services 0% or 20%
Prior Authorization Required for Ambulatory Surgical Center Services
Referral Required for Ambulatory Surgical Center Services
Outpatient Substance Abuse Care
In-Network:

Outpatient Substance Abuse Services:
Coinsurance for Medicare-covered Individual Sessions 0% or 20%
Coinsurance for Medicare-covered Group Sessions 0% or 20%
Prior Authorization Required for Outpatient Substance Abuse Services
Referral Required for Outpatient Substance Abuse Services
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0
  • Maximum plan benefit of $250.00 every three months for Over-The-Counter (OTC) Items
Maximum Plan Benefit of $250 every three months
$250/qtrly (Note: Unused OTC amounts roll over from quarter to quarter, but do not roll over to the next calendar year. Members may use their pre-loaded card on select OTC item(s) from plan approved catalog and item(s) are shipped to members. Additionally, members may use their pre-loaded card at select retail stores for select OTC items. Only the amount allocated for OTC items may be used on the pre-loaded card. (No cash is exchanged.)
Podiatry Services
In-Network:

Podiatry Services:
Coinsurance for Medicare-Covered Podiatry Services 0% or 20%
Prior Authorization Required for Podiatry Services
Referral Required for Podiatry Services
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
Copayment for Skilled Nursing Facility Services per Stay $0
Prior Authorization Required for Skilled Nursing Facility Services
Referral Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:

Medicare Covered Preventive Dental:
Coinsurance for Office Visit 0% or 20%

Non-Medicare Covered Preventive Dental:
Copayment for Non-medicare preventive $0
Copayment for Oral exams $0
  • Maximum 2 visits every year
Copayment for Dental x-rays $0
  • Maximum 1 visit every year
Copayment for Prophylaxis $0
  • Maximum 2 visits every year

Non-Medicare Covered Comprehensive Dental:
Copayment for Non-medicare comprehensive $0
Copayment for Restorative services $0
Copayment for Endodontics $0
Copayment for Periodontics $0
Copayment for Prothodontics, removable $0
Copayment for Maxillofacial prosthetics $0
Copayment for Prothodontics, fixed $0
Copayment for Maxillofacial surgery $0
Copayment for Adjunctive general services $0
Maximum Plan Benefit of $4,000 every year

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Coinsurance for Medicare Covered Benefits 0% or 20%
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exam every year

Eyewear:
Coinsurance for Medicare-Covered Benefits 0% or 20%
Copayment for Contact Lenses $0
Copayment for Eyeglass Lenses $0
Copayment for Eyeglass Frames $0
Copayment for Upgrades $0
Maximum Plan Benefit of $200 every year

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Coinsurance for Medicare Covered Benefits 0% or 20%
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0

Hearing Aids:
Copayment for Hearing Aids $0
  • Maximum 2 Hearing Aids every year
Maximum Plan Benefit of $2,000 every year

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit

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