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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 Roanoke/Alleghany. 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 $7000.00 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. For example, in the initial coverage phase, you will pay $10 for a 30-day supply of a preferred generic drug at a preferred pharmacy, or $20 at a standard pharmacy. The plan also has a $0 copay for specialty tier drugs and mail order for preferred generic drugs.
Additional Benefits
The Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. You'll find no copay for many services, such as home health and dental cleanings, while others, like specialist visits and emergency services, have copays ranging from $15 to $110. Additionally, the plan includes coverage for hearing and vision services with set copays or maximum benefits, as well as dental coverage for many services with no copay or a $35 copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 6 days, there is a $285 copay, and for days 7-90, there is no copay. Additional days are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a $325 copay, Ambulatory Surgical Center (ASC) Services have a $300 copay, and Outpatient Substance Abuse Services (Individual and Group Sessions) are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $35 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a copay of $285.00. Transportation services to plan-approved health-related locations are covered for up to 36 one-way trips per year, while 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 by the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $15 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $50 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $15 copay, and routine chiropractic care has a $15 copay for up to 12 visits per year. Occupational therapy services have a $20 copay, and specialist services have a $20 copay. Individual and group sessions for mental health and psychiatric services have a $20 copay. Podiatry services have a $20 copay for routine foot care (up to 8 visits per year). Physical therapy and speech-language pathology services have a $20 copay. Other health care professional services have a copay between $0 and $20.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, health education, Personal Emergency Response Systems, Re-admission Prevention, additional sessions of smoking and tobacco cessation counseling, fitness benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, nutritional/dietary benefits, 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, 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 hearing exams with a $10 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered, with a limit of 1 routine exam and 3 fitting/evaluation visits per year, respectively. Prescription hearing aids (all types) are covered with a maximum benefit of $2,000 per year, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams, with one exam covered every year, and eyewear, including contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $200. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment with no copay, as well as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP) plan with a coinsurance between 20% and 20%.
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, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a copay between $0 and $85, while diagnostic radiological services have a maximum copay of $285. Therapeutic radiological services have a 20% coinsurance and a maximum copay of $20, and outpatient X-ray services have no copay. 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover 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, and copays apply.
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. There is no copay for days 1-20, and a $214 copay for days 21-100. 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 covers Over-the-Counter (OTC) items, with a maximum benefit coverage of $143 every three months. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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