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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. During the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, the copay for a standard generic drug is $17.00, while a non-preferred drug has a 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), you will pay $0.00 for your Part D drugs.
Additional Benefits
The CommuniCare Advantage CSNP (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, ambulance, and some medical equipment have coinsurance. Primary care, preventive services, and home health services have copays or coinsurance. The plan also covers dental, vision, and hearing services, with specific limits and copays or coinsurance for certain services. Additionally, this plan covers home infusion, dialysis, and skilled nursing facility services, though some require prior authorization and may have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $375 for days 1-5 and $0 for days 6-90 for Inpatient Hospital-Acute, and a copay of $325 for days 1-5 and $0 for days 6-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services and observation services, both with a 20% coinsurance, as well as ambulatory surgical center (ASC) services and outpatient substance abuse services. Individual and group sessions for outpatient substance abuse have a $40 copay. Outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
CommuniCare Advantage CSNP (HMO C-SNP) covers partial hospitalization with a $55 copay. Prior authorization is required for coverage of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance, and Transportation Services to a plan-approved health-related location are covered for up to 36 one-way trips per year. 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 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 is not covered.
Primary Care See details
CommuniCare Advantage CSNP (HMO C-SNP) covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a $10-$50 copay. The plan also covers mental health specialty services, including individual and group sessions, with a $35 copay, and physical therapy and speech-language pathology services with a $40 copay. Additionally, the plan covers other health care professionals with a $50 copay, psychiatric services with a $40 copay, and opioid treatment program services with a $35 copay.
Preventive Services See details
Preventive Services are covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan. Kidney Disease Education Services have a $10 copay, and Other Preventive Services including 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, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams and routine hearing exams are covered, and you are eligible for 1 routine hearing exam per year. Fitting/evaluation for hearing aids is covered, and there is no limit to the benefit. Prescription hearing aids (all types) are covered, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a maximum plan benefit of $250 every year, and no deductible. Eyewear is covered, including contact lenses and eyeglasses (lenses and frames), while 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 are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for Home Infusion bundled Services.
Dialysis Services See details
Dialysis Services are covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home. Diabetic Equipment includes Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but does not cover Diabetic Supplies.
Diagnostic and Radiological Services See details
The CommuniCare Advantage CSNP (HMO C-SNP) plan covers Diagnostic and Radiological Services. Diagnostic Procedures/Tests and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray 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. This benefit requires prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan. 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CommuniCare Advantage CSNP (HMO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $194.50 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The Other Services benefit covers meal benefits, but requires prior authorization and a doctor's referral. Acupuncture, over-the-counter items, Dual Eligible SNPs, 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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