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

Available to residents of Tyrrell County, NC for 2027. Contract H9147, plan 001, segment 0.

2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.

Renewed for 2027. CMS carries this plan forward from 2026. Every NC plan’s 2026–2027 changes →

Plan details

Monthly premium (Part C + D)	$13.20
— medical (Part C) part	$0.00
— drug (Part D) part	$13.20?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,850.00?
Drug deductible	$700.00Tier 1, 2 and 6 exempt
Drug out-of-pocket threshold	$2,400.00
Plan type	HMO-POS D-SNP?
Special needs plan	Dual-eligible SNP
D-SNP integration status	Coordination Only (CO)
Zero-dollar cost sharing D-SNP	Yes
Contract / plan	H9147-001-0
Offered by	Blue Cross and Blue Shield of North Carolina
Parent organization	CuraCor Solutions Corp.
Formulary tiers	6
Formulary exception tier	4?
Pharmacy search	www.bluecrossnc.com/members/medicare/prescription-drug
Member services	(866)760-4610TTY 711

CMS star ratings

Overall: 3 out of 5 stars for Overall
Health plan (Part C): 3 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 2.5 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H9147 shares this rating.

Plan health benefits

Service	In-network
Doctor visits
Primary care doctor	20% coinsurance
Specialist	20% coinsurance
Other health care professional	20% coinsurance
Additional telehealth services	20% coinsurance(authorization required)
Preventive care
Medicare-covered preventive services	$0 copay
Annual physical exam	$0 copay
Kidney disease education	$0 copay
Glaucoma screening	20% coinsurance
Diabetes self-management training	20% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	20% coinsurance(authorization required)
Lab services	20% coinsurance(authorization required)
Diagnostic radiology (e.g. MRI, CT)	20% coinsurance(authorization required)
Therapeutic radiology	20% coinsurance(authorization required)
Outpatient x-rays	20% coinsurance(authorization required)
Emergency and urgent care
Emergency room	$115 copay
Urgent care	$40 copay
Worldwide emergency coverage	$0 copay · $100,000 plan limit
Worldwide urgent care	$0 copay · $100,000 plan limit
Worldwide emergency transportation	$0 copay
Hospital care
Inpatient hospital stay	Original Medicare cost-sharing(authorization required)
Outpatient hospital services	20% coinsurance(authorization required)
Outpatient observation	20% coinsurance
Ambulatory surgical center	20% coinsurance(authorization required)
Outpatient blood services	20% coinsurance
Skilled nursing and home health
Skilled nursing facility	Original Medicare cost-sharing(authorization required)
Home health care	$0 copay(authorization required)
Kidney dialysis	20% coinsurance
Rehabilitation
Occupational therapy	20% coinsurance
Physical therapy and speech-language therapy	20% coinsurance
Cardiac rehabilitation	$30 copay
Pulmonary rehabilitation	$25 copay
Mental health and substance use
Inpatient psychiatric hospital stay	Original Medicare cost-sharing(authorization required)
Outpatient mental health, individual session	20% coinsurance
Outpatient mental health, group session	20% coinsurance
Psychiatrist, individual session	20% coinsurance
Psychiatrist, group session	20% coinsurance
Partial hospitalization	20% coinsurance(authorization required)
Intensive outpatient program	20% coinsurance(authorization required)
Outpatient substance use, individual session	20% coinsurance
Outpatient substance use, group session	20% coinsurance
Opioid treatment program	20% coinsurance
Ambulance and transportation
Ground ambulance	20% coinsurance(authorization required)
Air ambulance	20% coinsurance(authorization required)
Transportation to plan-approved locations	$0 copay
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)
Medical supplies	20% coinsurance(authorization required)
Diabetes supplies	20% coinsurance(authorization required)
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	20% coinsurance
Routine chiropractic care	Not covered
Acupuncture	Not covered
Foot exams and treatment (Medicare-covered)	20% coinsurance
Routine foot care	$0 copay
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)
Preventive dental plan limit	$3,000 plan limit every year
Oral exams	$0 copay(limits apply)
Cleanings	$0 copay(limits apply)
Fluoride treatment	$0 copay(limits apply)
Dental x-rays	$0 copay(limits apply)
Other diagnostic dental services	Not covered
Other preventive dental services	Not covered
Restorative services (fillings, crowns)	$0 copay(limits apply)
Endodontics (root canals)	$0 copay(limits apply)
Periodontics (gum disease)	$0 copay(limits apply)
Dentures and other removable prosthodontics	$0 copay(limits apply)
Maxillofacial prosthetics	Not covered
Implants	Not covered
Bridges and other fixed prosthodontics	Not covered
Oral and maxillofacial surgery	$0 copay(limits apply)
Orthodontics	Not covered
Adjunctive general services	$0 copay(limits apply)
Vision?
Eye exam (Medicare-covered)	20% coinsurance(limits apply)
Routine eye exam	$0 copay(limits apply)
Eyewear after cataract surgery (Medicare-covered)	20% coinsurance(limits apply)
Contact lenses	$0 copay(limits apply)
Eyeglasses (frames and lenses)	$0 copay(limits apply)
Eyeglass lenses	$0 copay(limits apply)
Eyeglass frames	$0 copay(limits apply)
Eyewear upgrades	Not covered
Hearing?
Hearing exam (Medicare-covered)	20% coinsurance
Routine hearing exam	$0 copay(limits apply)
Hearing aid fitting and evaluation	$0 copay(limits apply)
Hearing aids (all types)	$0 copay(limits apply)
Hearing aids, inner ear	Not covered
Hearing aids, outer ear	Not covered
Hearing aids, over the ear	Not covered
Medicare Part B drugs
Part B insulin	$35 copay(authorization required, step therapy may apply)
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)
Other extra benefits?
Over-the-counter (OTC) allowance	$236 allowance every month
Meals after a hospital stay or for a chronic condition	$0 copay(referral required)
Fitness benefit	$0 copay
Health education	Not covered
Nutritional / dietary benefit	Not covered
Extra smoking and tobacco cessation counseling	$0 copay
Enhanced disease management	Not covered
Telemonitoring	Not covered
Remote access technologies (web/phone, nurse line)	Not covered
Home and bathroom safety devices	Not covered
Counseling services	Not covered
In-home safety assessment	Not covered
Personal emergency response system (PERS)	$0 copay
Medical nutrition therapy	Not covered
Post-discharge in-home medication reconciliation	Not covered
Re-admission prevention	Not covered
Wigs for hair loss from chemotherapy	Not covered
Weight management programs	Not covered
Alternative therapies	Not covered
Therapeutic massage	Not covered
Adult day health services	Not covered
Home-based palliative care	Not covered
In-home support services	Not covered
Support for caregivers	$0 copay

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2027). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1 · Preferred Generic	$0.00
Tier 2 · Generic	$0.00
Tier 3 · Preferred Brand	25%
Tier 4 · Non-Preferred Drug	25%
Tier 5 · Specialty Tier	25%
Tier 6 · Select Care Drugs	$0.00

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	25%	25%	25%	25%	25%	25%
Tier 4: Non-Preferred Drug	25%	25%	25%	25%	25%	25%
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Tier 6: Select Care Drugs	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.

Star rating measures

Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H9147 shares it.

Benefits in plain text

Healthy Blue + Medicare (HMO-POS D-SNP) (H9147-001-0) is a 2027 HMO-POS D-SNP Medicare Advantage plan offered by Blue Cross and Blue Shield of North Carolina, available to residents of Tyrrell County, NC.

The monthly premium is $13.20.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,850.00.

The drug deductible is $700.00. Tier 1, 2 and 6 exempt.

It is a special needs plan (Dual-eligible SNP).

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $0.00; tier 3 (Preferred Brand): 25%; tier 4 (Non-Preferred Drug): 25%; tier 5 (Specialty Tier): 25%; tier 6 (Select Care Drugs): $0.00.

CMS gives the plan's contract (H9147) an overall rating of 3 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.