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Abilis Health Community (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Abilis Health Community (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Abilis Health Community (HMO I-SNP) in 2026, please refer to our full plan details page.
Abilis Health Community (HMO I-SNP) is a HMO I-SNP plan offered by BrightSpring Health Services, Inc. available for enrollment in 2025 to people living in KY (partial). This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Abilis Health Community (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Abilis Health Community (HMO 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 Abilis Health Community (HMO 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 Abilis Health Community (HMO 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. Additionally, this plan comes with a Part B Premium reduction of $35.50. You must continue to pay paying your reduced 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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 Abilis Health Community (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this initial cost is an essential step when evaluating your overall healthcare budget and prescription drug needs. Specific details regarding drug coverage tiers, copayments, and coinsurance amounts are currently unavailable for this plan. To determine how your specific medications are covered and what your ongoing costs will be after meeting the deductible, you should consult the plan's formulary directly.
Additional Benefits
The Abilis Health Community (HMO I-SNP) plan offers robust medical coverage with affordable cost-sharing, featuring no copay or coinsurance for preventive care, home health services, and diagnostic laboratory tests. For routine doctor visits, members pay no copay to a fifteen dollar copay for primary care and up to a forty dollar copay for specialists, with no coinsurance. Inpatient hospital stays require a four hundred dollar daily copay for the first five days followed by no copay, while outpatient hospital services and durable medical equipment generally require a twenty percent coinsurance and no copay. Supplemental benefits include preventive dental services with no copay or coinsurance, alongside comprehensive dental care covered at a twenty percent coinsurance up to a twenty-four hundred dollar annual limit. Vision and hearing benefits also feature no copays, though routine exams require a twenty percent coinsurance, which is balanced by a three hundred twenty-five dollar annual eyewear allowance and a four thousand dollar hearing aid limit every two years. Additionally, members receive an over-the-counter benefit of up to two hundred dollars every three months with no copay or coinsurance.
Inpatient Hospital See details
Abilis Health Community (HMO I-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $400 copay per day for days 1 through 5 and no copay for days 6 through 90, while psychiatric stays require a $374 copay per day for days 1 through 5 and no copay for days 6 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Abilis Health Community (HMO I-SNP) with no copay and a 20% coinsurance for outpatient hospital, observation, substance abuse, and blood services. Ambulatory surgical center services require a $200 copay and no coinsurance, with prior authorization required for some of these benefits.
Partial Hospitalization See details
Partial hospitalization is covered under the Abilis Health Community (HMO I-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Abilis Health Community (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Although transportation benefits are technically covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Abilis Health Community (HMO I-SNP) with a 20% coinsurance (up to $90 per visit) and no copay, which is waived if you are admitted to the hospital within one day. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are not covered.
Primary Care See details
Abilis Health Community (HMO I-SNP) covers primary care physician services with a $0 to $15 copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Physical, occupational, and speech therapy services are covered with no copay and a 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Abilis Health Community (HMO I-SNP) with no copay and no coinsurance for covered benefits like kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and remote access technologies. Non-covered services include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, fitness benefits, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Abilis Health Community (HMO I-SNP) provides partially covered hearing services with no copay for exams and prescription hearing aids, though routine exams require a 20% coinsurance with no deductible. Prescription hearing aids have no coinsurance with a $4,000 maximum benefit every two years, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Abilis Health Community (HMO I-SNP) covers vision services with no copays or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan includes one routine eye exam and one glaucoma screening annually, plus a $325 yearly allowance for eyewear including contacts, glasses, and upgrades.
Dental Services See details
Abilis Health Community (HMO I-SNP) offers preventive dental services, including two annual exams, cleanings, and x-rays, with no copay and no coinsurance, though fluoride, other diagnostic, and other preventive services are not covered. Comprehensive and Medicare-covered dental services, such as restorative care and implants, are covered with no copay and a 20% coinsurance up to a $2,400 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Abilis Health Community (HMO I-SNP) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Abilis Health Community (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Abilis Health Community (HMO I-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because diabetic supplies are not covered, while durable medical equipment, prosthetics, and diabetic therapeutic shoes or inserts are covered.
Diagnostic and Radiological Services See details
Abilis Health Community (HMO I-SNP) covers diagnostic and radiological services with no copays. Diagnostic procedures, tests, and lab services have no coinsurance, while diagnostic radiological services, therapeutic radiological services, and outpatient X-rays carry a 20% coinsurance.
Home Health Services See details
Abilis Health Community (HMO I-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Abilis Health Community (HMO I-SNP) covers some cardiac rehabilitation services with no copay and prior authorization required, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Abilis Health Community (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 30 and a $160 daily copay for days 31 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Abilis Health Community (HMO I-SNP) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance up to a $200 reimbursement limit every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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