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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 2025, please refer to our full plan details page.
HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) is a HMO C-SNP plan offered by HTA Holdings, LLC 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 2025.
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 $95.00 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 $3500.00 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 HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan has a $95 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at preferred and mail order pharmacies, but $15 at standard pharmacies. Non-preferred drugs have a 31% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your drugs.
Additional Benefits
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with a $225 copay, outpatient services with copays ranging from $15-$275, and emergency services with a $120 copay. It also includes coverage for vision, dental, hearing, and other medical services. This plan provides additional benefits like transportation services, home health services with no copay, and coverage for over-the-counter items up to $70 every three months. You will pay a copay for services like primary care, hearing exams, and dental exams. Some services require prior authorization, and some services have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric you will pay a $225 copay for days 1-8, and no copay for days 9-90. Additional Days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $275 copay, observation services, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse services have a $15 copay for both individual and group sessions, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP), with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare plans, are covered. Ground ambulance services have a $250 copay, and air ambulance services have a $300 copay; there is no coinsurance for either service. Transportation services to a plan-approved health-related location are covered for 48 one-way trips per year. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan. Emergency Services have a $120 copay and no coinsurance, while Urgently Needed Services have a $20 copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $75,000, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, physician specialist services have a copay between $0 and $15, individual and group mental health and psychiatric sessions have a $15 copay, physical therapy and speech-language pathology services have a $15 copay, additional telehealth benefits have a copay between $0 and $15, and opioid treatment program services have a $15 copay. Routine chiropractic care is not covered.
Preventive Services See details
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan covers preventive services, including annual physical exams, and other preventive services with prior authorization. Some services, like health education, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $15 copay, and routine hearing exams are limited to one per year with a copay of $25. Fitting/Evaluation for Hearing Aid has no limit. Prescription hearing aids have a copay between $299 and $799 for all types, with a limit of two per year. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0 - $15, and routine eye exams are covered once per year. Eyewear is covered up to a combined maximum of $175 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, each covered once per year.
Dental Services See details
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan covers a range of dental services, including oral exams with a $15 copay, dental x-rays with 0-20% coinsurance, and cleaning with no copay. Orthodontic services have a $100 deductible and are covered up to a $2500 maximum, while fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, which may have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, but does not cover Durable Medical Equipment for use outside the home. Prosthetics/Medical Supplies, Prosthetic Devices, and Medical Supplies are covered with a 20% coinsurance and Diabetic Supplies have a 0-20% coinsurance, but Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic Procedures/Tests have a copay between $0 and $100. Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300. Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the HealthTeam Advantage Diabetes & Heart Care (HMO C-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 the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
The HealthTeam Advantage Diabetes & Heart Care (HMO C-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $70 every three months. The plan also covers meal benefits for certain chronic illnesses and medical conditions. However, acupuncture, 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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* 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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