CareSource Dual Advantage (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by CareSource.
This page features plan details for 2022 CareSource Dual Advantage (HMO D-SNP) H3213 – 015 – 0 available in Region 1.
CareSource Dual Advantage (HMO D-SNP) is offered in the following locations.
CareSource Dual Advantage (HMO D-SNP) offers the following coverage and cost-sharing.
Special Needs Plan Type: | Dual-Eligible |
Conditions Covered: |
Insurer: | CareSource |
Health Plan Deductible: | $0 |
MOOP: | $7,550 In-network |
Drugs Covered: | Yes |
Ready to sign up for CareSource Dual Advantage (HMO D-SNP) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$170.10 | $0.00 | $0.00 | $0.00 | $170.10 |
CareSource Dual Advantage (HMO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $480.00 |
Initial Coverage Limit: | $4,430.00 |
Catastrophic Coverage Limit: | $7,050.00 |
Drug Benefit Type: | Enhanced |
Gap Coverage: | No Gap Coverage |
Formulary Link: | Formulary Link |
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$0.00 | $22.30 | $14.90 | $7.50 | $0.00 |
After you pay your $480.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
Drug Type | Cost Share |
---|---|
Generic drugs | 25% |
Brand-name drugs | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Tier | Cost |
---|---|
Generic | $4.15 copay or 5% (whichever costs more) |
Brand-name | $10.35 copay or 5% (whichever costs more) |
CareSource Dual Advantage (HMO D-SNP) also provides the following benefits.
In-Network: No |
Diagnostic services: | $0 copay (limits may apply) |
Endodontics: | $0 copay (limits may apply) |
Extractions: | $0 copay (limits may apply) |
Non-routine services: | $0 copay (limits may apply) |
Periodontics: | $0 copay (limits may apply) |
Prosthodontics, other oral/maxillofacial surgery, other services: | $0 copay (limits may apply) |
Restorative services: | $0 copay (limits may apply) |
Cleaning: | $0 copay (limits may apply) |
Dental x-ray(s): | $0 copay (limits may apply) |
Fluoride treatment: | $0 copay (limits may apply) |
Oral exam: | $0 copay (limits may apply) |
Diagnostic radiology services (e.g., MRI): | $0 copay (authorization required) |
Diagnostic tests and procedures: | $0 copay (authorization required) |
Lab services: | $0 copay (authorization required) |
Outpatient x-rays: | $0 copay (authorization required) |
Primary: | $0 copay |
Specialist: | $0 copay |
Emergency: | $0 copay |
Urgent care: | $0 copay |
Foot exams and treatment: | $0 copay |
Routine foot care: | Not covered |
$0 copay |
$0.00 |
In-Network: No |
Fitting/evaluation: | $0 copay (limits may apply) |
Hearing aids: | $0 copay (limits may apply) |
Hearing exam: | $0 copay |
$0 copay (authorization required) |
$0 copay (authorization required) |
$7,550 In-network |
Diabetes supplies: | $0 copay (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 copay (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | $0 copay (authorization required) |
Chemotherapy: | $0 copay (authorization required) |
Other Part B drugs: | $0 copay (authorization required) |
Inpatient hospital – psychiatric: | $0 copay (authorization required) |
Outpatient group therapy visit with a psychiatrist: | $0 copay |
Outpatient group therapy visit: | $0 copay |
Outpatient individual therapy visit with a psychiatrist: | $0 copay |
Outpatient individual therapy visit: | $0 copay |
No |
$0 copay |
Occupational therapy visit: | $0 copay (authorization required) |
Physical therapy and speech and language therapy visit: | $0 copay (authorization required) |
$0 copay (authorization required) |
$0 copay (limits may apply) |
Contact lenses: | $0 copay (limits may apply) |
Eyeglass frames: | $0 copay (limits may apply) |
Eyeglass lenses: | $0 copay (limits may apply) |
Eyeglasses (frames and lenses): | Not covered |
Other: | Not covered |
Routine eye exam: | $0 copay (limits may apply) |
Upgrades: | Not covered |
Covered |
Ready to sign up for CareSource Dual Advantage (HMO D-SNP) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
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