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

New Mexico Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$36
by Blue Cross and Blue Shield of New Mexico

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.0
out of 5 stars

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Plan Name
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP)
Insurance Carrier
Blue Cross and Blue Shield of New Mexico
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in New Mexico and offered by the health insurance company Blue Cross and Blue Shield of New Mexico. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$36
Annual Deductible
$0 or $240 per year for in-network services.
Max Out-of-Pocket
$8,850
Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit
ER visit
0% or 20% coinsurance per visit (always covered)
Ambulance
0% or 20% coinsurance

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) has a monthly premium cost of $36 per month, with an annual deductible of $0 or $240 per year for in-network services. and a maximum out of pocket cost sharing of $8,850 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Not covered
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) received an overall government quality rating of 3.0 stars out of 5 stars.

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) performed the same as New Mexico’s State average overall quality score of 3.0 stars.

This Plan’s 5-star Gov’t Quality Score
New Mexico State Average Score
Overall Government 5 Star Quality Rating
 3.0
 3.0
Summary rating of health plan quality
 3
 3.0
Staying healthy: screenings, tests, & vaccines
 4
 3.0
Managing chronic (long term) conditions
 3
 2.6
Member experience with health plan
 1
 2.0
Member complaints & changes in the health plan's performance
 4
 3.6
Health plan customer service
 4
 4.4
Summary rating of drug plan quality
 3
 3.1
Drug plan customer service
 4
 4.2
Member complaints & changes in the drug plan's performance
 4
 3.6
Member experience with the drug plan
 1
 2.0
Drug safety & accuracy of drug pricing
 3
 2.8

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) received 3 stars for its health plan quality score which is the same as the New Mexico State average health plan quality score of 3.0 stars.

Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) received 3 stars for its drug plan quality score which is worse than the New Mexico State average drug plan quality score of 3.1 stars.


Monthly Premium
$36
Health Portion of Premium
$0
Drug Portion of Premium
$36
Health Plan Deductible
$0 or $240 per year for in-network services.
Health Plan Max Out-of-Pocket
$8,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
0% or 20% coinsurance per visit
Specialist visit
0% or 20% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
0% or 20% coinsurance
Outpatient x-rays
0% or 20% coinsurance
Emergency care
0% or 20% coinsurance per visit (always covered)
Urgent care
0% or 20% coinsurance per visit (always covered)

Hospital Services

Inpatient hospital coverage
In 2024 the amounts for each benefit period are $0 or:
$1,632 deductible for days 1 through 60
$408 copay per day for days 61 through 90
Outpatient hospital coverage
0% or 20% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In 2024 the amounts for each benefit period are $0 or:
$0 copay for days 1 through 20
$204 copay per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
0% or 20% coinsurance

Therapy services

Occupational therapy visit
0% or 20% coinsurance
Physical therapy & speech & language therapy visit
0% or 20% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
0% or 20% coinsurance
Outpatient individual therapy with a psychiatrist
0% or 20% coinsurance
Outpatient group therapy visit
0% or 20% coinsurance
Outpatient individual therapy visit
0% or 20% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
0% or 20% coinsurance per item
Prosthetics (like braces, artificial limbs)
0% or 20% coinsurance per item
Diabetes supplies
0% or 20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
0% or 0-20% coinsurance
Other Part B drugs
0% or 0-20% coinsurance

Hearing

Hearing exam
0% or 20% coinsurance
Fitting/evaluation
$0 copay
Hearing aids - All types
$0 copay

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
Not covered
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
$0 copay
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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