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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 2025, 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 out of 5 stars in 2025.
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 $26.30. 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 $590.00 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 $9350.00 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) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Sentara Community Complete Select (HMO D-SNP) plan offers a range of additional benefits to help cover your healthcare needs. The plan has a coinsurance of 20% for many services, including outpatient services, primary care, hearing, vision, and dental. The plan also covers services such as ambulance, home health, and medical equipment. In addition to the core benefits, this plan provides coverage for hearing aids up to $2,000 per year, and offers dental services including oral exams, X-rays, cleanings, and fluoride treatments, plus orthodontic services up to $4,000 per year. There is also a $150 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered. Copays apply for inpatient hospital services, and prior authorization is required.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while ASC services, outpatient substance abuse services, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Sentara Community Complete Select (HMO D-SNP) plan. This benefit requires prior authorization and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Sentara Community Complete Select (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, with no copay, and the coinsurance is waived if admitted to the hospital within 24 hours. Worldwide Emergency Services has a maximum benefit coverage of $50,000.
Primary Care See details
The Sentara Community Complete Select (HMO D-SNP) plan covers Primary Care Physician Services with a 20% coinsurance. Chiropractic Services, including routine care, are covered with a 20% coinsurance, with a limit of 12 visits per year. Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Other Health Care Professional services are covered with a 20% coinsurance. Mental Health Specialty Services, including individual and group sessions, and Psychiatric Services, including individual and group sessions, are covered with a minimum and maximum coinsurance of 20%. The plan also covers Podiatry Services, including routine foot care, with a 20% coinsurance, up to 8 visits per year. Additional Telehealth Benefits and Opioid Treatment Program Services are also covered.
Preventive Services See details
Preventive services are covered, including annual physical exams and additional services. Kidney Disease Education Services, Glaucoma Screening, and Diabetes Self-Management Training have a 20% coinsurance, while Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered but have a 20% coinsurance. 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, Enhanced Disease Management, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications are also covered. 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, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20% and routine hearing exams, as well as fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a plan-specified amount of $2000.00 per year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and include routine eye exams once per year. Eyewear is covered with a 20% coinsurance, and includes coverage for contact lenses and eyeglasses (lenses and frames), with a combined maximum of $300 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services with 20% coinsurance. Other dental services include oral exams (1 every 12 months), dental x-rays (1), prophylaxis (cleaning) (2 every 12 months), and fluoride treatments (2 every 12 months). Orthodontic services are covered up to a maximum of $4,000 per year. Restorative services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are also covered, but with a limited number of visits. 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 with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Sentara Community Complete Select (HMO D-SNP) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered by the Sentara Community Complete Select (HMO D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices and Diabetic Supplies also have a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. For all diagnostic services and outpatient radiological services, there is no copay. Diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Sentara Community Complete Select (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the sub-services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. This plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays for SNF.
Other Services See details
The Sentara Community Complete Select (HMO D-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 with a maximum benefit of $150.00 every three months.
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