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Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) in 2025, please refer to our full plan details page.
Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in Greater Hampton Roads Area. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Sentara Medicare Engage-Diabetes and Heart (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:
Sentara Medicare Engage-Diabetes and Heart (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 Sentara Medicare Engage-Diabetes and Heart (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 Sentara Medicare Engage-Diabetes and Heart (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 a $150.00 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 $3500.00 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 Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan has a $150 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you can expect to pay a $10 copay for preferred generic drugs at a preferred pharmacy, and $42 for standard generic drugs. For non-preferred drugs, you will pay 31% coinsurance, while specialty tier drugs have no copay.
Additional Benefits
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan offers a variety of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a copay, and outpatient services. You'll also find coverage for ambulance services, emergency services, and a range of primary care services, often with copays. Preventive services like annual exams are covered with no copay, alongside hearing and vision services. Dental services include no copay for some services but do have copays for restorative work. The plan also covers home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, cardiac rehabilitation, and skilled nursing facility services. Additionally, it offers an over-the-counter allowance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. For days 1-5 of inpatient hospital stays, there is a $275 copay, and days 6-90 have no copay; additional days for both acute and psychiatric care are also covered with no copay.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center Services, and Outpatient Blood Services, are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center Services have a $300 copay, while Outpatient Substance Abuse Services (Individual and Group Sessions) are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan, but requires prior authorization. You will have a $35 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $290 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 36 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $15 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $50 copay.
Primary Care See details
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services with a $10 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $10 copay, Mental Health Specialty Services with a $20 copay for individual and group sessions, Podiatry Services with a $10 copay for routine foot care, Other Health Care Professional with a copay between $0-$20, Psychiatric Services with a $20 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services.
Preventive Services See details
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan covers preventive services, including annual physical exams and additional preventive services, with no copay. Additional services covered include Health Education, Personal Emergency Response System (PERS), Re-admission Prevention, Nutritional/Dietary Benefit, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $15 copay, fitting/evaluation for hearing aids, and prescription hearing aids up to $2000 every year; however, prescription hearing aids for the inner ear and outer ear, and OTC hearing aids are not covered. This plan covers 1 routine hearing exam and 3 fitting/evaluation visits every year.
Vision Services See details
Vision services include coverage for routine eye exams once per year, with no deductible. Eyewear is covered with a combined maximum benefit of $200 per year for all eyewear, and contact lenses and eyeglasses (lenses and frames) are covered with no limits, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include no copay for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment are covered with details in the plan, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with a $35 copay. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The coinsurance for Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $85, and diagnostic radiological services with a copay up to $285. The plan also covers therapeutic radiological services with a copay up to $15 and 20% coinsurance, as well as outpatient X-ray services with no copay. However, lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF are not covered, and non-Medicare-covered stays for SNF are also not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, which provides up to $130 every three months, and includes nicotine replacement therapy (NRT). Acupuncture, meal benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and other services are not covered.
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