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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 2026, 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 Maryland and Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $615.00 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 $9250.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay a $6 copay for a one-month supply at standard pharmacies, or a $5 copay through standard mail order. Tier 2 generic drugs are available with a $17 standard pharmacy copay or a $15 standard mail order copay for a one-month supply. Tier 3 preferred brand drugs cost $45 at standard pharmacies and $40 through standard mail order for a one-month supply. For Tier 4 non-preferred drugs, the one-month copay is $92 at standard pharmacies and $90 through mail order, while Tier 5 specialty drugs require a 25% coinsurance. Multi-month supplies for Tiers 1 through 4 are also available to help manage your ongoing prescription medication costs.
Additional Benefits
The CommuniCare Advantage CSNP (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care doctor visits, telehealth services, and home health care. For specialized care, specialist visits require a copay ranging from $10 to $50, while emergency room visits carry a $90 copay. Inpatient hospital stays require a daily copay for the first five days, after which there is no copay for days 6 through 90. This plan also features robust supplemental benefits, including dental, vision, and hearing services with no copays or coinsurance up to generous annual limits. Members can access up to $2,000 in dental benefits, a $2,500 hearing aid allowance, and a $250 vision allowance annually. Additionally, the plan covers up to 36 one-way routine transportation trips per year to approved health locations with no copay or coinsurance.
Inpatient Hospital See details
CommuniCare Advantage CSNP (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $375 copay for days 1 through 5 of acute stays and a $325 copay for days 1 through 5 of psychiatric stays, followed by no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CommuniCare Advantage CSNP (HMO C-SNP) covers outpatient hospital services with no copay and 20% coinsurance, and ambulatory surgical center services with no copay and 10% coinsurance. Outpatient substance abuse individual and group sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay and 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by CommuniCare Advantage CSNP (HMO C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
CommuniCare Advantage CSNP (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. The plan also covers up to 36 one-way transportation trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by CommuniCare Advantage CSNP (HMO C-SNP) with a $90.00 copay and no coinsurance, and urgently needed services are covered with a $40.00 copay and no coinsurance. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
CommuniCare Advantage CSNP (HMO C-SNP) provides primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits range from a $10.00 to $50.00 copay with no coinsurance. Other services like therapy and psychiatric care carry copays between $35.00 and $40.00 with no coinsurance, but chiropractic services are not covered in practice as routine and other chiropractic care are excluded.
Preventive Services See details
Preventive services are partially covered by CommuniCare Advantage CSNP (HMO C-SNP), featuring no copay for zero-dollar preventive services and a $10 copay with no coinsurance for kidney disease education. Select services like glaucoma screenings and diabetes self-management training carry no copay but require a 10% coinsurance, while annual physical exams and additional benefits like fitness programs and health education are not covered.
Hearing Services See details
CommuniCare Advantage CSNP (HMO C-SNP) covers hearing services with no copay, no coinsurance, and no deductible, providing up to a $2,500 annual maximum for one routine hearing exam, unlimited fitting evaluations, and prescription hearing aids. This benefit is partially covered, as OTC hearing aids along with inner ear, outer ear, and over the ear prescription hearing aids are not covered, and prior authorization is required for prescription aids.
Vision Services See details
CommuniCare Advantage CSNP (HMO C-SNP) provides partially covered vision services with no copay, no coinsurance, and no deductible, up to a $250 annual maximum. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, while other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
CommuniCare Advantage CSNP (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum benefit of $2,000 per year. While most diagnostic, preventive, and comprehensive dental services are covered at no cost, fluoride treatment, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
CommuniCare Advantage CSNP (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance with no copay.
Dialysis Services See details
Dialysis Services are covered by CommuniCare Advantage CSNP (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
CommuniCare Advantage CSNP (HMO C-SNP) provides partial coverage for Medical Equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
CommuniCare Advantage CSNP (HMO C-SNP) covers diagnostic and radiological services with prior authorization, requiring a 20% coinsurance and a copay for diagnostic procedures, alongside a $3.00 copay and coinsurance for lab services. Radiological services, including X-rays, diagnostic, and therapeutic radiology, require no copay but are subject to a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by CommuniCare Advantage CSNP (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CommuniCare Advantage CSNP (HMO C-SNP) with no coinsurance and required prior authorization. While some services are covered, standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by CommuniCare Advantage CSNP (HMO C-SNP) with no coinsurance and does not require a prior three-day hospital stay. Members pay no copay for days 1 through 20 and a $194.50 daily copay for days 21 through 100, with prior authorization required and additional days beyond the standard Medicare-covered limit not covered.
Other Services See details
CommuniCare Advantage CSNP (HMO C-SNP) partially covers other services, offering a chronic illness meal benefit with no copay and no coinsurance, though prior authorization and a referral are required. Acupuncture and Over-the-Counter (OTC) items are not covered under this benefit.
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