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CommuniCare Advantage CSNP (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CommuniCare Advantage CSNP (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CommuniCare Advantage CSNP (HMO C-SNP) in 2025, please refer to our full plan details page.
CommuniCare Advantage CSNP (HMO C-SNP) is a HMO C-SNP plan offered by SNP Holdings, LLC available for enrollment in 2025 to people living in Indiana, Maryland and Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that CommuniCare Advantage CSNP (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:
CommuniCare Advantage CSNP (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 CommuniCare Advantage CSNP (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 CommuniCare Advantage CSNP (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 $590.00 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 $9350.00 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 CommuniCare Advantage CSNP (HMO C-SNP) plan has a $590 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, your cost depends on the drug tier and the pharmacy you use. For example, you may pay a $17 copay for a standard pharmacy preferred generic drug, or a $92 copay for a standard pharmacy preferred brand drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for Part D.
Additional Benefits
The CommuniCare Advantage CSNP (HMO C-SNP) plan offers a variety of benefits, including inpatient hospital stays with copays ranging from $0-$788 depending on the days and type of care. Outpatient services, such as substance abuse treatment, have copays, while primary care and preventive services have no copay. Dental services have a maximum coverage of $2000 per year. This plan also covers ambulance services with coinsurance, transportation to health-related locations, and emergency services with copays. Hearing and vision services are included, with specific limitations on hearing aids and eyeglass upgrades. Home health services and skilled nursing facilities are covered with no or low copays, while other services like home infusion, dialysis, and medical equipment have varying coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-5, and a $0 copay for days 6-90, and a $788 copay for days 1-60. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and a $0 copay for days 6-90, and a $788 copay for days 1-60.
Outpatient Services See details
Outpatient Services includes outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ambulance Services have no copay, but do require a 20% coinsurance 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 under the CommuniCare Advantage CSNP (HMO C-SNP) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
CommuniCare Advantage CSNP (HMO C-SNP) covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay for routine care, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $10-$50 copay, and Mental Health Specialty Services with a $35 copay for individual and group sessions. The plan also covers Other Health Care Professional services with a $50 copay, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $40 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with a $35 copay.
Preventive Services See details
CommuniCare Advantage CSNP (HMO C-SNP) covers Medicare-covered preventive services, with no copay. Kidney Disease Education Services have a $10 copay, and other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 10% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no deductible. Hearing exams have a maximum plan benefit coverage of $2500 every year. Routine hearing exams are limited to 1 per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams, contact lenses, and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CommuniCare Advantage CSNP (HMO C-SNP) plan covers a maximum of $2000 per year for dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered, while fluoride treatment, adjunctive general services, 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 by the CommuniCare Advantage CSNP (HMO C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 CommuniCare Advantage CSNP (HMO C-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for 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 are covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan. Diagnostic Procedures/Tests and Diagnostic and Therapeutic Radiological Services have a coinsurance of at most 20%, and Lab Services have a $3 copay.
Home Health Services See details
Home Health Services are covered by the CommuniCare Advantage CSNP (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 specific sub-services of 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 are not covered. Prior authorization is required, and more copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan. There is no copay for days 1-20, and a $194.50 copay for days 21-100.
Other Services See details
Other Services include a meal benefit, which is covered with prior authorization and a doctor referral, but acupuncture, over-the-counter items, 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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