Healthy Blue Dual Advantage (D-SNP HMO), Washington Parish, LA
Healthy Blue Dual Advantage, plan H1947-001-0, is a D-SNP Medicare Advantage plan, by Healthy Blue. It has a HMO provider network. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part A and Part B.
This plan is rated 3.0 (Average) stars by CMS. See MedicareWire's review below. You must meet all qualification requirements to join this D-SNP plan.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- This is a Medicare Special Needs Plan, with a HMO provider network, exclusively for people with Medicare and Medicaid benefits (dual-eligible).
- This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
- To qualify, you must live in Washington Parish and have both Medicare Part A and Part B. Plus, you must qualify for full Medicaid.
- Healthy Blue Dual Advantage includes a Medicare Part D prescription drug plan.
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- If you qualify for the Social Security "Extra Help" program, you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copayments.
- Healthy Blue Dual Advantage provides the same coverage benefits as Medicare Part A and Part B (Original Medicare) and includes some extra benefits not covered by Original Medicare.
- If you are not qualified to enroll, one of the traditional Medicare Advantage plans available in Washington Parish, Louisiana might be your best option.
- 2024 costs and benefits for Healthy Blue Dual Advantage will be available in early October. Get Notification.
| H1947-001-0 Plan Basics | |
|---|---|
| Plan ID: | H1947-001-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $33.80/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 In-network |
| Drug Plan Benefit: | Enhanced $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | Dental, Vision, Hearing |
| Availability: | Washington Parish, LA |
| Insured By: | Healthy Blue |
Health Plan Costs & Benefits
Healthy Blue Dual Advantage is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Healthy Blue Dual Advantage does allow out-of-network care for emergencies and out-of-area dialysis.
Premiums, deductibles, and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
Healthy Blue Dual Advantage's total monthly premium in Washington Parish is $33.80. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
Healthy Blue Dual Advantage's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this Healthy Blue plan is $8,300 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this Healthy Blue plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $8,300 In-network |
| Doctor Visits | |
| Primary | $0 copay |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient group therapy visit | $0 copay (authorization required) |
| Outpatient group therapy visit with a psychiatrist | $0 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (authorization required) |
| Outpatient individual therapy visit | $0 copay (authorization required) |
| Rehabilitation Services | |
| Physical therapy and speech and language therapy visit | $0 copay (authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Outpatient x-rays | $0 copay (authorization required) |
| Lab services | $0 copay (authorization required) |
| Diagnostic radiology services (e.g., MRI) | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Chemotherapy | $0 copay (authorization required) |
| Foot Care (podiatry Services) | |
| Foot exams and treatment | $0 copay (authorization required) |
| Hearing | |
| Hearing exam | $0 copay (authorization required) |
| Hearing aids | $0 copay (authorization required, limits may apply) |
| Preventive Dental | |
| Fluoride treatment | $0 copay (limits may apply) |
| Oral exam | $0 copay (limits may apply) |
| Cleaning | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Diagnostic services | $0 copay (authorization required, limits may apply) |
| Endodontics | $0 copay (authorization required, limits may apply) |
| Extractions | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (authorization required, limits may apply) |
| Restorative services | $0 copay (authorization required, limits may apply) |
| Periodontics | $0 copay (authorization required, limits may apply) |
| Vision | |
| Contact lenses | $0 copay (limits may apply) |
| Eyeglass frames | $0 copay (limits may apply) |
| Routine eye exam | $0 copay (authorization required, limits may apply) |
| Eyeglasses (frames and lenses) | $0 copay (limits may apply) |
| Upgrades | $0 copay (limits may apply) |
| Eyeglass lenses | $0 copay (limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 copay |
| Ground ambulance | $0 copay |
| Inpatient hospital coverage | $0 copay |
| Outpatient hospital coverage | $0 copay |
| Skilled Nursing Facility | $0 copay |
| Optional supplemental benefits | No |
Feel free to download our Healthy Blue Dual Advantage Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Healthy Blue Dual Advantage includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formulary. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $33.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $33.80 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $8.40 |
| Part D Premium with 50% LIS Assistance: | $16.90 |
| Part D Premium with 25% LIS Assistance: | $25.30 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Healthy Blue begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Healthy Blue Dual Advantage has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $10.00 copay | $10.00 copay |
| 2 (Generic) | $20.00 copay | $20.00 copay |
| 3 (Preferred Brand) | $40.00 copay | $40.00 copay |
| 4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay |
| 5 (Specialty Tier) | 25% | 25% |
| 6 (Select Care Drugs) | $10.00 copay | $10.00 copay |
Our Review & 2023 CMS Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories. MedicareWire does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)
In terms of quality, this Louisiana D-SNP plan is just average. From MedicareWire's viewpoint, anyone looking for a D-SNP HMO plan that prioritizes preventive health (i.e., screenings, tests, vaccines, etc.) may be disapointed with Healthy Blue Dual Advantage because the plan's score is below average. When it comes to helping members manage their chronic health conditions, this plan does an average job. The member experience with this Healthy Blue plan is average. When it comes to complaints and changes in performance, this plan is below average.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Healthy Blue Dual Advantage
To qualify for enrollment in Healthy Blue Dual Advantage in Washington Parish, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Louisiana's state thresholds.
Before enrolling in Healthy Blue Dual Advantage, or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary? What if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- Peoples Health Secure Complete
- UnitedHealthcare Dual Complete
- Wellcare Dual Access Medicare
- Humana Gold Plus SNP-DE H1951-034
- Vantage DUAL PLUS
Contact Healthy Blue
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://shop.healthybluela.com/medicare |
|---|---|
| Formulay Information: | https://shop.anthem.com/medicare |
| Pharmacy Information: | Healthy Blue Pharmacy Page |
| Prospective Members: | (855)593-0912 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
Citations & References
- Healthy Blue, http://shop.healthybluela.com/medicare, Last Accessed October 13, 2022
- Medicaid.gov, "Medicaid & CHIP in Louisiana", Last Accessed January 20, 2023
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
- CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
- CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
- CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023