Community Advantage Plus (HMO D-SNP)

Community Advantage Plus (HMO D-SNP) is a HMO D-SNP plan offered by IMPERIAL COUNTY LOCAL HEALTH AUTHORITY available for enrollment in 2026 to people living in Imperial County. The overall rating for this plan is not yet available for 2026.

It's important to know that Community Advantage Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Community Advantage Plus (HMO D-SNP).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Community Advantage Plus (HMO D-SNP) plan features an Enhanced Alternative prescription drug benefit with an annual deductible of $615.00. During the initial coverage phase, you will pay a 25% coinsurance at standard pharmacies for Tier 1 preferred generics, Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs. For Tier 5 specialty drugs, there is no copay at standard pharmacies. If you qualify for the low-income subsidy, also known as Extra Help, your Part D premium may be reduced to $12.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions.

Additional Benefits

The Community Advantage Plus (HMO D-SNP) plan generally features no copayments for most medical services, instead relying on a standard 20% coinsurance for outpatient care, emergency visits, primary and specialist care, and medical equipment. Major services like inpatient hospital stays and skilled nursing facility care require Medicare-defined coinsurance with no copay, though prior authorizations are frequently needed. Home health services stand out as fully covered with no copays or coinsurance. For supplemental benefits, the plan provides dental coverage up to $2,000 annually and vision coverage with a $250 allowance every two years for eyewear, both requiring no copay and a 20% coinsurance. Routine hearing exams are also covered with no copay and up to 20% coinsurance, though hearing aids are not covered. Additionally, members can receive reimbursement for over-the-counter items with no copay or coinsurance, but the plan does not cover cardiac rehabilitation, routine transportation, or meal benefits.