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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 Central 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 $3800.00 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 will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, preferred generic drugs have a $10 copay at preferred pharmacies, while standard mail order has no copay. Non-preferred drugs have 31% coinsurance, and specialty tier drugs have no copay.
Additional Benefits
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll have access to primary care, hearing, vision, and dental services, with specific copays and coverage limits for each. The plan also covers emergency and ambulance services, as well as home health services with no copay, and offers additional benefits like over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with a $300 copay for days 1-5, and no copay for days 6-90. Additional days for both services are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $250 copay. Individual and group sessions for outpatient substance abuse have a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Both ground and air ambulance services have a copay of $255. 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 are covered with a $140 copay and no coinsurance, while Urgently Needed Services have a $15 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered with a $50 copay and no coinsurance, with a maximum plan benefit of $50,000.
Primary Care See details
Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $20 copay. The plan also covers mental health specialty services and psychiatric services, with a $30 copay for individual and group sessions, podiatry services with a $20 copay, other health care professional services with a copay between $0 and $30, 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, health education, personal emergency response systems, re-admission prevention, and fitness benefits. It also covers additional sessions for smoking and tobacco cessation counseling, nutritional/dietary benefits, in-home support services, 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 EKGs following a welcome visit. In-Home Safety Assessment, Medical Nutrition Therapy, 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
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan covers hearing exams with a $20 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (3 per year). The plan also covers prescription hearing aids up to $2000 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with a combined maximum benefit of $200 every year, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Contact lenses and eyeglasses (lenses and frames) are covered.
Dental Services See details
Dental services include no copay for other dental services, including exams, x-rays, cleaning, and fluoride treatments, and a $35 copay for restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery services. Orthodontic services are covered up to a maximum of $2500 per year. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
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 outpatient X-Ray services with no copay; lab services are not covered, while therapeutic radiological services have a coinsurance up to 20% and a copay up to $25, and diagnostic radiological services have a copay up to $275.
Home Health Services See details
Home Health Services are covered 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 not covered by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation 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. For days 1-20, there is no copay, and for days 21-100, the copay is $214.00. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan's "Other Services" benefit covers Over-the-Counter (OTC) items with a maximum plan benefit coverage amount of $144.00 every three months, including Nicotine Replacement Therapy (NRT). Acupuncture, Meal Benefit, 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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