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Healthy Blue + Medicare (HMO-POS D-SNP)

Healthy Blue + Medicare (HMO-POS D-SNP) H9147-001 Plan Details
3.5 out of 5 stars

Healthy Blue + Medicare (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Healthy Blue + Medicare
Plan ID: H9147-001

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Healthy Blue + Medicare (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Healthy Blue + Medicare
Plan ID: H9147-001

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Healthy Blue + Medicare (HMO-POS D-SNP) H9147-001 Plan Details
3.5 out of 5 stars

Healthy Blue + Medicare (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Healthy Blue + Medicare
Plan ID: H9147-001

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

North Carolina Counties Served

Iredell Alamance Davidson Forsyth Davie Yadkin Chatham Surry Pasquotank Duplin Rowan Wilkes Vance Stokes Anson Randolph Rockingham Northampton Polk Montgomery Moore Caswell Guilford Harnett Orange Lee Durham Person Richmond Johnston Wake Wayne Wilson Franklin Warren Nash Transylvania Graham Gaston Hyde Edgecombe Hertford Chowan Beaufort Martin Halifax Gates Greene Dare Perquimans Camden Stanly Jones Currituck Lincoln Tyrrell Washington Catawba Burke Cleveland Pender Rutherford Mecklenburg Cabarrus Mcdowell Brunswick Pamlico Union Swain Sampson Scotland Hoke New Hanover Cumberland Robeson Columbus Bladen Ashe Yancey Lenoir Caldwell Alexander Jackson Avery Watauga Alleghany Buncombe Henderson Cherokee Mitchell Haywood Clay Madison Macon Granville Bertie Carteret Pitt Onslow Craven

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $9350
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
In-Network:
$0.00 copay
Specialty Doctor Visit
In-Network:
$0.00 copay
Inpatient Hospital Care
In-Network:
$0.00 copay per stay
Urgent Care
Urgent Care: $0.00 copay
Emergency Room Visit
Emergency Care: $0.00 copay
Worldwide Coverage: This plan covers urgent care and emergency services when traveling outside of the United States for less than six months. This benefit is limited to $100,000 per year.
Ambulance Transportation
Ground Ambulance: $0.00 copay Per Trip
Air Ambulance: $0.00 copay

Health Care Services and Medical Supplies

Healthy Blue + Medicare (HMO-POS D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Medicare Covered Chiropractic Services: $0.00 copay
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Diabetic Supplies: $0.00 copay
Durable Medical Eqipment (DME)
In-Network:
$0.00 copay
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:
Lab Services: $0.00 copay
X-Rays: $0.00 copay
Therapeutic Radiological Services: $0.00 copay
Outpatient Diagnostic Procedures/Tests: $0.00 copay
Diagnostic Radiological Services: $0.00 copay
Home Health Care
In-Network:
$0.00 copay
Mental Health Inpatient Care
In-Network:
$0.00 copay per stay
Mental Health Outpatient Care
In-Network:
Individual and Group Sessions: $0.00 copay
Outpatient Services / Surgery
In-Network:
Outpatient Hospital - Surgery: $0.00 copay
Observation Services: $0.00 copay
Ambulatory Surgical Center: $0.00 copay
Outpatient Substance Abuse Care
In-Network:
Individual and Group Sessions: $0.00 copay
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0
  • Maximum plan benefit of $0.00 every month for Over-The-Counter (OTC) Items
Combined Supplemental Benefit package includes OTC, Food and Produce, and Home and Bathroom Safety Devices allowance. Quitline Program for smoking cessation, the following is available at no cost: 12-wk regimen of combination therapy NRT for up to 2 quit attempts per yearNRT (available for 2 quit attempts, total 24 weeks) Monotherapy (1 type of NRT) Gum = 12 wks = 2 boxes shipment 1, 2 boxes shipment 2, 1 box shipment 3 Lozenge = 12 wks = 4 boxes shipment 1, 1 box shipment 2, 1 box shipment 3 Patch = 1 shipment (4 wk supply of 28 patches)CNRT (combination NRT) Patch + Gum 12 wks = 1 patch + 2 boxes gum shipment 1, 1 patch + 1 box gum shipment 2, 1 patch shipment 3 Patch + Lozenge 12 wks = 1 patch + 2 boxes lozenge shipment 1, 1 patch + 1 box lozenge shipment 2, 1 patch shipment 3
Podiatry Services
In-Network:
Medicare Covered Podiatry Services: $0.00 copay
Routine Foot Care: $0.00 copay
Unlimited routine foot care visits each year.
Skilled Nursing Facility Care
In-Network:
$0.00 copay per stay

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network and POS (Out-of-Network):
This plan covers 2 oral exam(s), 2 cleaning(s), 1 fluoride, and 1 dental X-ray(s) every year.

In-Network:
Medicare Covered Dental: $0.00 copay
Preventive Dental Services: $0.00 copay
Comprehensive Dental Services: $0.00 copay

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:
Medicare Covered Eye Exam: $0.00 copay
Routine Eye Exam: $0.00 copay
This plan covers 1 routine eye exam(s) every year.
Medicare Covered Eye Wear: $0.00 copay
Routine Eye Wear: $0.00 copay
This plan covers up to $400 for eyeglasses or contact lenses every year.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:
Medicare Covered Hearing Exam: $0.00 copay
Routine Hearing Exam: $0.00 copay for routine hearing exam(s). $0.00 copay for hearing aids up to the maximum plan benefit amount.
This plan covers 1 routine hearing exam every year. $300 maximum plan benefit for over-the-counter hearing aids OR 1 routine hearing aid fitting evaluation and a $3,000 maximum plan benefit for prescribed hearing aids every year.

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services

Prescription Drug Costs and Coverage

The Healthy Blue + Medicare (HMO-POS D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $0
Preferred Generic
  • Standard mail order $0.00
  • Standard retail $0.00
Generic
  • Standard mail order $0.00
  • Standard retail $0.00
Select Care Drugs
  • Standard mail order $0.00
  • Standard retail $0.00
Annual Drug Deductible $0
Preferred Generic
  • Standard mail order $0.00
  • Standard retail $0.00
Generic
  • Standard mail order $0.00
  • Standard retail $0.00
Select Care Drugs
  • Standard mail order $0.00
  • Standard retail $0.00
Annual Drug Deductible $0
Preferred Generic
  • Standard mail order $0.00
  • Standard retail $0.00
Generic
  • Standard mail order $0.00
  • Standard retail $0.00
Select Care Drugs
  • Standard mail order $0.00
  • Standard retail $0.00
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