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HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) in 2026, please refer to our full plan details page.
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) is a HMO C-SNP plan offered by Risant Health, Inc. available for enrollment in 2025 to people living in Piedmont Triad Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthTeam Advantage Diabetes & Heart Care (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:
HealthTeam Advantage Diabetes & Heart Care (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 HealthTeam Advantage Diabetes & Heart Care (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 HealthTeam Advantage Diabetes & Heart Care (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 $300.00 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 $3900.00 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:
Sign up for HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP)
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Drug Coverage
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) prescription drug plan features an annual drug deductible of $300. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when using preferred pharmacies or standard mail order services. If you choose standard pharmacies, copays start at $10 for Tier 1 and $20 for Tier 2 medications. For brand-name and specialty drugs, your costs will be based on coinsurance instead of copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs cost 40% coinsurance at preferred pharmacies and 50% at standard pharmacies. Specialty medications in Tier 5 carry a 29% coinsurance for a one-month supply at all available pharmacies.
Additional Benefits
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care visits and preventive services. For inpatient hospital stays, members pay a $300 daily copay for the first six days with no copay thereafter, while outpatient hospital services require a $300 copay. Emergency care is available with a $150 copay, and skilled nursing facility stays have no copay for the first 20 days followed by a $218 daily copay. Supplemental benefits include preventive dental care with no copay, and comprehensive dental services covered up to a $1,500 annual limit with a deductible and 0% to 50% coinsurance. Routine vision and hearing exams require a $25 copay, with additional allowances for eyewear and hearing aids. The plan also provides up to 48 one-way transportation trips per year and a $70 quarterly over-the-counter reimbursement with no copay.
Inpatient Hospital See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization. Acute stays require a $300 daily copay for days 1 through 6 (no copay for days 7 and beyond), while psychiatric stays require a $300 daily copay for days 1 through 8 (no copay for days 9 through 90). This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP), featuring a $300 copay and no coinsurance for outpatient hospital services, and a $175 copay with no coinsurance for ambulatory surgical center services. Outpatient substance abuse sessions require a $25 copay with no coinsurance, while outpatient blood services are available with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP), featuring a $250 copay for ground ambulance and a $300 copay for air ambulance, with no coinsurance for either service. Transportation is partially covered, providing up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance (waived if admitted to the hospital within 3 days), and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $50,000 maximum with no copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) covers primary care and podiatry services with no copay and no coinsurance, while specialist and telehealth visits range from a $0 to $25 copay with no coinsurance. Physical, occupational, speech, psychiatric, and mental health therapies require a $25 copay and no coinsurance, but routine chiropractic services are not covered.
Preventive Services See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance (prior authorization required), but do not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP), offering routine hearing exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $299 to $799 and no coinsurance for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP), as other eye exam services are not covered. Routine eye exams are covered with a $25 copay and no coinsurance (limited to one per year), while eyewear is covered with no copay and no coinsurance up to a $100 annual maximum benefit.
Dental Services See details
Dental services are partially covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP), featuring no copay and no coinsurance for preventive care such as exams and cleanings, and a $25 copay with no coinsurance for Medicare-covered dental. Comprehensive services require a deductible and have a $1,500 annual limit with no copay and 0% to 50% coinsurance, but fluoride treatments, other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has no copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) partially covers medical equipment, as diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment, prosthetics, medical supplies, and diabetic supplies require prior authorization and feature no copay, with coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required. Diagnostic tests range from a $0 to $100 copay with no coinsurance, lab services and diagnostic radiology have no copay, outpatient x-rays require a $10 copay, and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan. This is because all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) with no coinsurance, requiring prior authorization and allowing admission with less than a three-day prior hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) partially covers other services, which include over-the-counter items with a $70 quarterly reimbursement limit and chronic illness meal benefits, both available with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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