True Blue Special Needs Plan (HMO D-SNP)

H9656 - 001 - 0
Plan Not Rated

True Blue Special Needs Plan (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Blue Cross of Idaho.

This page features plan details for 2024 True Blue Special Needs Plan (HMO D-SNP) H9656 – 001 – 0 available in Select Counties in Idaho.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

True Blue Special Needs Plan (HMO D-SNP) is offered in the following locations.

Plan Overview

True Blue Special Needs Plan (HMO D-SNP) offers the following coverage and cost-sharing.

Special Needs Plan Type:Dual-Eligible
Conditions Covered:
Insurer:Blue Cross of Idaho
Health Plan Deductible:
MOOP:
Drugs Covered:Yes
Please Note:
  • This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
  • Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.

Ready to sign up for True Blue Special Needs Plan (HMO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

True Blue Special Needs Plan (HMO D-SNP) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$174.70 $0.00 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

True Blue Special Needs Plan (HMO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$545.00
Initial Coverage Limit:$5,030.00
Catastrophic Coverage Limit:$8,000.00
Drug Benefit Type:Basic
Additional Gap Coverage:No
Formulary Link: Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

NOTE:  The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.

Initial Coverage Phase

After you pay your $545.00 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 $5,030.00. Once you reach that amount, you will enter the next coverage phase.

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

True Blue Special Needs Plan (HMO D-SNP) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$8,300 In-network

Optional supplemental benefits

No

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

$0 copay (Authorization is required.) (Referral is not required.)

Doctor visits

Primary$0 copay (Not applicable.) (Not applicable.)
Specialist$0 copay (Authorization is not required.) (Referral is not required.)

Preventive care

$0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$0 copay (Not applicable.) (Not applicable.)
Urgent care$0 copay (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$0 copay (Authorization is not required.) (Referral is not required.)
Lab services$0 copay (Authorization is not required.) (Referral is not required.)
Diagnostic radiology services (e.g., MRI)$0 copay (Authorization is required.) (Referral is not required.)
Outpatient x-rays$0 copay (Authorization is required.) (Referral is not required.)

Hearing

Hearing exam$0 copay (Authorization is not required.) (Referral is not required.)
Fitting/evaluation$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
Hearing aids$599-899 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
CleaningNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Diagnostic servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
PeriodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Rehabilitation services

Occupational therapy visit$0 copay (Authorization is not required.) (Referral is not required.)
Physical therapy and speech and language therapy visit$0 copay (Authorization is not required.) (Referral is not required.)

Ground ambulance

$0 copay (Not applicable.) (Not applicable.)

Transportation

$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Foot care (podiatry services)

Foot exams and treatment$0 copay (Authorization is not required.) (Referral is not required.)
Routine foot care$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)$0 copay (Authorization is required.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)$0 copay (Authorization is required.) (Not applicable.)
Diabetes supplies$0 copay (Authorization is not required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

Chemotherapy$0 copay (Authorization is required.) (Not applicable.)
Other Part B drugs$0 copay (Authorization is required.) (Not applicable.)
Part B Insulin drugs$0 copay (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$0 copay (Authorization is required.) (Referral is not required.)

Mental health services

Inpatient hospital – psychiatric$0 copay (Authorization is required.) (Referral is not required.)
Outpatient group therapy visit with a psychiatrist$0 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit with a psychiatrist$0 copay (Authorization is not required.) (Referral is not required.)
Outpatient group therapy visit$0 copay (Authorization is not required.) (Referral is not required.)
Outpatient individual therapy visit$0 copay (Authorization is not required.) (Referral is not required.)

Skilled Nursing Facility

$0 copay (Authorization is required.) (Referral is not required.)

Ready to sign up for True Blue Special Needs Plan (HMO D-SNP) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

8am – 11pm EST. 7 days a week

Table of Contents