Blue Shield TotalDual Plan (HMO D-SNP)
Blue Shield of California · HMO D-SNP · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $7
- Higher than most plans here
- Most you pay in a year for covered care in network
- $9,250
- Drug deductible
- $615
- Tied for highest here
- Medicare star rating
- 3.5 of 5
This is a special needs plan. Only some people can join: Dual-Eligible.
In plain English
Compared with the 8 other plans in Los Angeles County that the same person could join.
What stands out
- Dental, vision and hearing extras included
Watch out for
- $7 monthly premium, higher than most plans here
- $615 drug deductible, tied for highest here
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$84$84 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.Not counted, because the plan charges a percentage: Primary care visit, Lab tests.
- A busier year$84$84 in premiums + $0 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, X-rays, Urgent care.
- A hard year$84$84 in premiums + $0 for care6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Primary care visit, Specialist visit, Lab tests, MRI, CT and other scans, Ground ambulance, Emergency room, Hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit20%
- Specialist visit0% to 20%Depends on the serviceReferral needed
- Urgent care20%
- Emergency room20%
- Lab tests20%Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral needed
- MRI, CT and other scans20%Referral needed
- Ground ambulance20%Plan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 8 other plans in Los Angeles County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $0 |
| 3Preferred BrandAfter the deductible | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 25% of the price |
| 5Specialty TierAfter the deductible | 25% of the price |
For a 1-month supply. The $615 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.
- Vision IncludedRoutine eye exam covered. Glasses or contacts covered.Eyewear has a limit; ask the plan.
- Hearing IncludedRoutine hearing test covered. Hearing aids covered.Hearing tests: plan pays up to $1,500 a year. Hearing aids: plan pays up to $1,500 a year, both ears.
- Over-the-counter items IncludedUp to $120 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included48 one-way rides to medical visits a year.
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Blue Shield TotalDual Plan (HMO D-SNP), plan number H2819-001, for 2026?”