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CommuniCare Advantage ISNP (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CommuniCare Advantage ISNP (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CommuniCare Advantage ISNP (HMO I-SNP) in 2025, please refer to our full plan details page.
CommuniCare Advantage ISNP (HMO I-SNP) is a HMO I-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 ISNP (HMO I-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 ISNP (HMO I-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 ISNP (HMO I-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 ISNP (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.60. 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 ISNP (HMO I-SNP) plan has a $590 deductible for prescription drugs. This means you must pay this amount out-of-pocket before your drug coverage begins. After your deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), the plan's premium is $49.60. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The CommuniCare Advantage ISNP (HMO I-SNP) plan offers coverage for a wide range of healthcare services. This plan includes coverage for inpatient and outpatient hospital services, ambulance services with no copay, and a $100 copay for emergency services. Primary care, hearing, vision, and dental services are also covered, with varying cost-sharing amounts for each service. Additional benefits include coverage for home health services with no copay, and a quarterly allowance for over-the-counter items. However, some services like worldwide emergency services, certain preventive services, and specific types of hearing aids are not covered. The plan utilizes coinsurance for many services, and prior authorization may be required for some.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Both services require prior authorization and have coinsurance, while additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including 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 and three pints of blood are waived. Ambulatory Surgical Center services have a coinsurance between 10% and 10%. Outpatient Substance Abuse Services have a coinsurance of 20% for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan. This benefit requires prior authorization and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance, and transportation services to any health-related location are covered for up to 36 one-way trips per year.
Emergency Services See details
Emergency Services are covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan, with a $100 copay, and no coinsurance. Urgently Needed Services are covered with a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The CommuniCare Advantage ISNP (HMO I-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have a 20% coinsurance. Occupational therapy services, physical therapy, and speech-language pathology services have no coinsurance.
Preventive Services See details
Preventive Services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no copay and no coinsurance. This plan covers prescription hearing aids (all types), but does not cover inner ear, outer ear, or over-the-ear hearing aids, or OTC hearing aids. There is a maximum benefit of $2,000 every year for hearing exams.
Vision Services See details
Vision services include eye exams, with a maximum plan benefit of $250. Routine eye exams are covered with no copay, and eyeglasses (lenses and frames) are covered with no copay. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $2,000 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered. However, fluoride treatment, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 ISNP (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment are covered. Durable medical equipment has a 10% coinsurance, and a prior authorization is required; however, durable medical equipment for use outside the home is not covered. Prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes/inserts all have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan with no copay or coinsurance. 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 the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum benefit of $150 every three months. Acupuncture, Meal Benefit, 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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