In-network
Inpatient hospital
inpatient copayment is selected but its amount is missing
● CMS 2026 plan record
Blue adVantage Dual Plus (HMO-POS D-SNP)
Emergency transport
Ambulance
Ground · in-network20% coinsurance
Air · in-network20% coinsurance
Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group
Emergency services
Emergency room
20% coinsurance
Waived if admitted within 72 hours
Medical maximum
Maximum out-of-pocket
In-network$9,250
Combined in + outNot reported
Skilled care at home
Home health
In-networkVerify in plan documents
Out-of-networkNot separately reported
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$18.20 / month
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.
About this code
What H6453-019-000 identifies
H6453-019-000 is a Contract Year 2026 Medicare plan segment code. The compact form H6453019000 refers to the same normalized contract, plan, and segment shown on this page.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.