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Sentara Community Complete Select (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sentara Community Complete Select (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sentara Community Complete Select (HMO D-SNP) in 2026, please refer to our full plan details page.
Sentara Community Complete Select (HMO D-SNP) is a HMO D-SNP plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in State of Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Sentara Community Complete Select (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Sentara Community Complete Select (HMO D-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 Community Complete Select (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.
For Sentara Community Complete Select (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.60. 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 $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 Sentara Community Complete Select (HMO D-SNP) prescription drug coverage includes an annual drug deductible of $615. You will need to pay this deductible amount out-of-pocket for your covered medications before the plan begins to cover its portion of your drug costs. Specific details regarding drug tiers, copays, and coinsurance are not available for this plan. To determine your exact coverage and potential out-of-pocket expenses, you should verify how your specific prescriptions are covered under this plan's formulary.
Additional Benefits
Sentara Community Complete Select (HMO D-SNP) offers comprehensive medical coverage where most outpatient services, primary care, specialist visits, and emergency care require no copay and a 20% coinsurance. Inpatient hospital stays feature no coinsurance, though Medicare-defined cost sharing applies, while home health and skilled nursing facility services are covered with no copay and no coinsurance. For supplemental benefits, the plan provides preventive and comprehensive dental care up to a $4,000 annual limit and prescription hearing aids up to a $2,000 annual limit, both with no copay and no coinsurance. Members also receive up to 40 one-way transportation trips per year to approved locations and a $135 monthly allowance for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Sentara Community Complete Select (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though Medicare-defined cost sharing applies and prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Sentara Community Complete Select (HMO D-SNP) covers outpatient services, including hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Sentara Community Complete Select (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Sentara Community Complete Select (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transportation. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Sentara Community Complete Select (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered with no copay and no coinsurance up to a maximum benefit limit of $100,000.
Primary Care See details
Sentara Community Complete Select (HMO D-SNP) covers primary care, specialist, mental health, therapy, and podiatry services with no copay and a 20% coinsurance. Chiropractic benefits are partially covered with no copay and 20% coinsurance for routine care, though other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Sentara Community Complete Select (HMO D-SNP), offering no copay and no coinsurance for annual physicals and select additional services, though a 20% coinsurance applies to kidney disease education, glaucoma screenings, and diabetes self-management. Sub-services that are not covered under this benefit include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, telemonitoring, and counseling services.
Hearing Services See details
Sentara Community Complete Select (HMO D-SNP) covers hearing exams with no copay, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Sentara Community Complete Select (HMO D-SNP) with no copays, featuring a 20% coinsurance for routine eye exams (limited to one per year) and contact lenses. While eyeglasses and contact lenses are covered up to a combined maximum of $300 annually, other eye exams, upgrades, and separate eyeglass lenses or frames are not covered.
Dental Services See details
Sentara Community Complete Select (HMO D-SNP) provides partially covered dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, alongside preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive services such as restorative care and periodontics are covered up to a $4,000 annual maximum with no copay and no coinsurance, while other diagnostic and preventive services, implants, orthodontics, maxillofacial prosthetics, and fixed prosthodontics are not covered.
Home Infusion bundled Services See details
Sentara Community Complete Select (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Sentara Community Complete Select (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Sentara Community Complete Select (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Sentara Community Complete Select (HMO D-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. This coverage applies to diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Sentara Community Complete Select (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Sentara Community Complete Select (HMO D-SNP) with no copay, no coinsurance, and prior authorization required, but some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Sentara Community Complete Select (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Sentara Community Complete Select (HMO D-SNP) partially covers other services, providing up to $135 monthly for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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