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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 Northern Virginia. 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 $4500.00 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. After the deductible, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, preferred generic drugs have a $10 copay at preferred pharmacies, while standard mail-order generic drugs have no copay. Specialty tier drugs and mail order drugs have no copay.
Additional Benefits
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. You'll have copays for inpatient hospital stays, outpatient services, and specialist visits. The plan also covers preventive services, hearing, vision, and dental services, with specific copays and maximum benefit amounts for certain services. Additional benefits include coverage for ambulance, emergency, and home health services. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays with specific cost-sharing amounts. The plan also offers an over-the-counter benefit with a quarterly allowance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $225 copay for days 1-8 and no copay for days 9-90. Additional days for both Inpatient Hospital-Acute and Psychiatric are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan, including Outpatient Hospital Services and Observation Services with a $255 copay, and Ambulatory Surgical Center (ASC) Services with a $200 copay. Outpatient Substance Abuse Services are partially covered, but Individual and Group Sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $35 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $280 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 services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $15 copay; both have no coinsurance. Worldwide Emergency Services has a $50 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with a maximum plan benefit coverage of $50,000.
Primary Care See details
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services with a $15 copay, mental health specialty services with a $20 copay for individual or group sessions, podiatry services with a $15 copay for routine foot care, other health care professional services with a copay between $0 and $20, psychiatric services with a $20 copay for individual or group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive services are covered, including an annual physical exam, additional preventive services, Health Education, Personal Emergency Response System (PERS), Re-admission Prevention, 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; 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. Nutritional/Dietary Benefit, In-Home Support Services, and Fitness Benefit are covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $15 copay, as well as fitting/evaluation for hearing aids, and prescription hearing aids (all types). Prescription hearing aids have a maximum plan benefit of $2,000 every year.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with a combined maximum plan benefit coverage amount of $200 every year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered. This plan also covers contact lenses and eyeglasses (lenses and frames).
Dental Services See details
Dental services include no copay for other dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment, with some limitations on the number of visits per year. Orthodontic services are covered up to a maximum of $2500 per year, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have 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 under the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan, with prior authorization required. 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 Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan, with Durable Medical Equipment (DME) and Prosthetic Devices covered at 20% coinsurance and no copay, and Medical Supplies covered at 20% coinsurance and no copay. 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 diagnostic procedures and tests with a copay of up to $85, while lab services are not covered. Diagnostic radiological services have a maximum copay of $265, and therapeutic radiological services have a 20% coinsurance and a maximum copay of $25. Outpatient X-ray services have no copay.
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 not covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD 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. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $120 every three months. 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, and Self-Directed Personal Assistance Services are not covered.
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