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Elite Care (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Elite Care (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Elite Care (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
Elite Care (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by Curana Health Holdings, LLC available for enrollment in 2025 to people living in Virginia (partial). This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Elite Care (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Elite Care (HMO-POS I-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 Elite Care (HMO-POS I-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 Elite Care (HMO-POS I-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 combined Maximum Out-Of-Pocket cost of $3300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Elite Care (HMO-POS I-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy type. For example, standard generic drugs have a $15 copay, while preferred brand drugs have a $95 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D costs are $0.
Additional Benefits
The Elite Care (HMO-POS I-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient hospital services, with varying copays and coinsurance. It also covers primary care, hearing, vision, and dental services, with specific cost-sharing structures for each. The plan includes additional benefits such as ambulance services and home health services, with some services requiring prior authorization. This plan provides coverage for emergency services and offers some preventive services, as well as home infusion and dialysis services. However, it does not cover some services such as cardiac rehabilitation, and some other services such as acupuncture and private duty nursing. The plan does cover over-the-counter items, including nicotine replacement therapy and naloxone.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $150 copay for days 1-10 and no copay for days 11-90; for Inpatient Hospital Psychiatric, you pay a $195 copay for days 1-8 and no copay for days 9-90. Upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Elite Care (HMO-POS I-SNP) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $225, observation services with a $100 copay, and ambulatory surgical center services with 20% coinsurance. The plan also covers outpatient substance abuse services, with a $30 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Elite Care (HMO-POS I-SNP) plan and requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Elite Care (HMO-POS I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Elite Care (HMO-POS I-SNP) plan. Emergency Services have a $90 copay with no coinsurance, and Urgently Needed Services have a $55 copay with no coinsurance; however, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Elite Care (HMO-POS I-SNP) plan covers primary care physician services, chiropractic services with 20% coinsurance, occupational therapy services with no copay or coinsurance, physician specialist services with a $10 copay, mental health specialty services with a copay, podiatry services with 20% coinsurance, other health care professional services with 20% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with no copay or coinsurance, additional telehealth benefits with a copay between $0 and $20, and opioid treatment program services. Chiropractic services require prior authorization.
Preventive Services See details
Preventive Services are covered, but Annual Physical Exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Other covered services include In-Home Support Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a coinsurance of at most 20% and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered up to a maximum of $1200 per year, and OTC hearing aids are also covered.
Vision Services See details
The Elite Care (HMO-POS I-SNP) plan covers vision services including eye exams and eyewear. Eye exams and eyewear each have a 20% coinsurance, and eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
The Elite Care (HMO-POS I-SNP) plan covers dental services with 20% coinsurance for Medicare Dental Services. Other Dental Services are covered with a maximum benefit of $3000 per year, and specific services like Oral Exams (2 visits per year), Dental X-Rays (2 per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (2 visits per year), Fluoride Treatment (1 visit every six months), Restorative Services (1 visit per year), Adjunctive General Services (1 visit per year), Endodontics (1 visit per year), Periodontics (1 visit per year), Prosthodontics (removable) (1 visit per year), Implant Services, Prosthodontics (fixed) (1 visit per year), and Oral and Maxillofacial Surgery (1 visit per year) are covered, while Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Elite Care (HMO-POS I-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, though Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for diagnostic services and radiological services, but with a coinsurance of at most 20% for diagnostic procedures, diagnostic radiological services, and therapeutic radiological services. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Elite Care (HMO-POS I-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Elite Care (HMO-POS I-SNP) plan, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for SNF services, and there is no cost sharing on the day of discharge.
Other Services See details
The Elite Care (HMO-POS I-SNP) plan does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Over-the-Counter (OTC) Items are covered, including Nicotine Replacement Therapy (NRT) and Naloxone, and the plan does not require authorization or referrals for additional services.
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