D-SNP Plan Costs & Benefits

CareFirst BlueCross BlueShield Advantage DualPrime 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, CareFirst BlueCross BlueShield Advantage DualPrime does allow out-of-network care for emergencies and out-of-area dialysis.

Private health plans are not standardized. Out-of-pocket costs, including premiums, deductibles, and copays, widely vary. We recommend reviewing and comparing plan costs carefully.

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 individual therapy visit	$0 copay (authorization required)
Outpatient individual therapy visit with a psychiatrist	$0 copay (authorization required)
Inpatient hospital - psychiatric	$0 copay (authorization required)
Outpatient group therapy visit	$0 copay (authorization required)
Rehabilitation Services
Occupational therapy visit	$0 copay (authorization required)
Medical Equipment / Supplies
Prosthetics (e.g., braces, artificial limbs)	$0 copay (authorization required)
Diabetes supplies	$0 copay (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Diagnostic radiology services (e.g., MRI)	$0 copay (authorization required)
Diagnostic tests and procedures	$0 copay (authorization required)
Lab services	$0 copay (authorization required)
Medicare Part B Drugs
Chemotherapy	$0 copay (authorization required)
Foot Care (podiatry Services)
Foot exams and treatment	$0 copay
Hearing
Hearing aids - over the ear	$0 copay (limits may apply)
Hearing aids - outer ear	$0 copay (limits may apply)
Hearing exam	$0 copay
Fitting/evaluation	$0 copay (limits may apply)
Preventive Dental
Dental x-ray(s)	$0 copay (limits may apply)
Cleaning	$0 copay (limits may apply)
Fluoride treatment	$0 copay (limits may apply)
Comprehensive Dental
Diagnostic services	Not covered
Restorative services	$0 copay (limits may apply)
Endodontics	$0 copay (limits may apply)
Non-routine services	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (limits may apply)
Extractions	$0 copay (limits may apply)
Vision
Contact lenses	$0 copay (limits may apply)
Eyeglass frames	Not covered
Routine eye exam	$0 copay (limits may apply)
Other	Not covered
Eyeglasses (frames and lenses)	$0 copay (limits may apply)
Eyeglass lenses	Not covered
Emergency Care / Urgent Care
Urgent care	$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

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that CareFirst BlueCross BlueShield Advantage DualPrime covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

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.

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 CareFirst BlueCross BlueShield begins paying its share.

Prescription Drug Plan Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, CareFirst BlueCross BlueShield Advantage DualPrime 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.

CMS Rating Marks

Each year the Centers for Medicare & Medicaid Services rates Medicare Advantage D-SNP's using nine broad categories. Medicare Wizard does not recommend enrolling in an SNP plan with an overall rating of less than 3.0. (3 out of 5 stars)

Do You Qualify to Join CareFirst BlueCross BlueShield Advantage DualPrime?

Unfortunately, not everyone on Medicare will qualify to join CareFirst BlueCross BlueShield Advantage DualPrime. To join a 2023 Medicare Special Needs Plan in Wicomico County, Maryland you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be age 65 or older. People with SSDI benefits for a disability qualify after 24 months.

Maryland Medicaid eligibility is based on your income and assets. Here are Maryland's Medicaid thresholds.

Medicare beneficiaries who don't qualify to enroll in CareFirst BlueCross BlueShield Advantage DualPrime, or another Special Needs Plan, are encouraged to look at Wicomico County Medicare Advantage plans options.

Contact CareFirst BlueCross BlueShield

The 2023 Medicare Special Needs Plans for Wicomico County, Maryland information on this page originates from Medicare.gov, is maintained by the All Medicare team, and was last updated on February 5, 2023.