Healthy Blue + Medicare (D-SNP) Plan Details for Johnston County, NC
This page provides coverage and cost details for Blue Cross and Blue Shield of North Carolina’s H9147-001-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this Blue Cross and Blue Shield of North Carolina plan (H9147-001-0) 3.5 (Above Average) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Dual-Eligible SNP qualification requirements to join this D-SNP plan.
Healthy Blue + Medicare Basic Plan Details
- Plan ID
- H9147-001-0
- Plan Type
- HMO-POS D-SNP
- Plan Year
- 2025
- Premium
- $0.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 9,350.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$590.00 deductible - Supplemental Benefits
- Vision, Hearing
- Availability
- Johnston County, NC
- Insured By
- Blue Cross and Blue Shield of North Carolina
| Summary of 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 Blue Cross and Blue Shield of North Carolina plan:
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $0 Copay
Prior Authorization Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $0 Copay
- Urgent care
- $0 Copay
- Ground ambulance
- $0 Copay
- Inpatient hospital care
- Coming Soon
- Skilled Nursing Facility
- Unknown
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
Prior Authorization Required - Routine Foot Care
- $0 Copay
Prior Authorization Required
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
Prior Authorization Required - Routine chiropractic
- $0 Copay
Prior Authorization Required
Mental Health Services
- Outpatient individual therapy
- $0 Copay
- Outpatient group therapy
- $0 Copay
- Inpatient psychiatric hospital care
- Coming Soon
Rehabilitation Services
- Physical therapy and speech and language therapy
- $0 Copay
Prior Authorization Required - Occupational therapy
- $0 Copay
Prior Authorization Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
- Durable medical equipment
- $0 Copay
Prior Authorization Required - Prosthetics
- $0 Copay
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $0 Copay
Prior Authorization Required - Lab services
- $0 Copay
Prior Authorization Required - Outpatient x-rays
- $0 Copay
Prior Authorization Required - Diagnostic tests and procedures
- $0 Copay
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- $0 Copay
- Other Part B drugs (Medicare-covered)
- $0 Copay
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
Prior Authorization Required - Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Covered
Limits may apply - Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- 20% Coinsurance
- Routine eye exam
- $0 Copay
1 Every year - Eyewear benefits
- None
Prescription Drug Costs & Benefits
Healthy Blue + Medicare includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $51.20 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Blue Cross and Blue Shield of North Carolina begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Healthy Blue + Medicare has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic* | $0.00 | $0.00 |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| Select Care Drugs* | $0.00 | $0.00 |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this Blue Cross and Blue Shield of North Carolina plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 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 + Medicare
To qualify for enrollment in Healthy Blue + Medicare in Johnston County, 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 North Carolina's state thresholds.
Before enrolling in Healthy Blue + Medicare , 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:
Contact Us About Blue Cross and Blue Shield of North Carolina
| Website: | Blue Cross and Blue Shield of North Carolina Plan Page (opens in new tab) |
|---|---|
| Providers: | Blue Cross and Blue Shield of North Carolina Providers Page (opens in new tab) |
| Formulary: | Blue Cross and Blue Shield of North Carolina Formulary Page (opens in new tab) |
| Pharmacy: | Blue Cross and Blue Shield of North Carolina Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (866)760-4610 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (866)760-4610 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits 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.
Health Plan Compatibility
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their local VA hospital.
Citations & References
- Blue Cross and Blue Shield of North Carolina, https://www.bluecrossnc.com/medicare, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in North Carolina", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.