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Astiva Health C-SNP Deluxe (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Astiva Health C-SNP Deluxe (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Astiva Health C-SNP Deluxe (HMO C-SNP) in 2025, please refer to our full plan details page.
Astiva Health C-SNP Deluxe (HMO C-SNP) is a HMO C-SNP plan offered by Astiva Health Holdings Incorporated available for enrollment in 2025 to people living in Counties: OC, LA, RIV, SB, SD. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Astiva Health C-SNP Deluxe (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Astiva Health C-SNP Deluxe (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Astiva Health C-SNP Deluxe (HMO C-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.
For Astiva Health C-SNP Deluxe (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Astiva Health C-SNP Deluxe (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, standard generic drugs have a $28 copay, while preferred brand drugs have a $75 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, you will pay $0.00.
Additional Benefits
The Astiva Health C-SNP Deluxe (HMO C-SNP) plan offers comprehensive coverage, including inpatient and outpatient services with varying copays. Emergency services have a $75 copay, while urgent care has no copay. You'll find coverage for hearing, vision, and dental services with specific limits and cost-sharing. This plan also provides additional benefits like transportation, home health, and medical equipment. Furthermore, it covers home infusion, dialysis, and skilled nursing facilities with specific copays or coinsurance. Some services, such as cardiac rehabilitation and certain preventive services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is no copay for days 1-5 and days 16-90, and a $180 copay for days 6-15. For Inpatient Hospital Psychiatric, there is no copay for days 1-5 and days 16-90, and a $180 copay for days 6-15.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $50 copay, observation services, ambulatory surgical center services, and outpatient substance abuse services with a $15 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $50 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Astiva Health C-SNP Deluxe (HMO C-SNP) plan, with a $50 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation Services to any health-related location are covered for up to 48 one-way trips per year via bus/subway or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Astiva Health C-SNP Deluxe (HMO C-SNP) plan. Emergency Services have a $75 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services and Other Health Care Professional benefits are covered, but require prior authorization and a doctor referral, while Routine Chiropractic Care is not covered. Occupational Therapy Services have a $15 copay, and Physical Therapy and Speech-Language Pathology Services have a $15 copay. Individual and Group Sessions for Psychiatric Services have a $25 copay.
Preventive Services See details
The Astiva Health C-SNP Deluxe (HMO C-SNP) plan covers preventive services, including additional preventive services like alternative therapies (80 visits) and therapeutic massage (80 sessions). Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit. However, annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams covered for one visit per year, and fitting/evaluation for hearing aids covered for two visits per year. Prescription hearing aids are covered up to $500 per year, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with no copay, and eyewear with a combined maximum plan benefit coverage amount of $300 every two years. Routine eye exams are limited to one per year, and contact lenses are limited to one pair every two years. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, and other dental services have a maximum plan benefit coverage of $350 every three months. Oral exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services are covered, and Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery are covered with copays ranging from $0 to $105. Orthodontics and Maxillofacial Prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, with Durable Medical Equipment (DME) covered with a coinsurance between 0% and 20%. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with coinsurance, while medical supplies and prosthetic devices are covered with 20% coinsurance. Diabetic equipment is covered, with coinsurance for Medicare-covered diabetic supplies and therapeutic shoes or inserts, and diabetic supplies and therapeutic shoes/inserts also covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Astiva Health C-SNP Deluxe (HMO C-SNP) plan. Diagnostic services have no copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $35.00, and Therapeutic Radiological Services have a coinsurance of up to 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Astiva Health C-SNP Deluxe (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Astiva Health C-SNP Deluxe (HMO C-SNP) plan; specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Astiva Health C-SNP Deluxe (HMO C-SNP) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Astiva Health C-SNP Deluxe (HMO C-SNP) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a limit of 80 treatments per year. The meal benefit covers up to $600 per year for a chronic illness with a doctor's referral. Some services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others.
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