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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 2026, 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 2026.
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 $38.40. 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 ISNP (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. This is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug tier details, including individual copayments and coinsurance rates for different medication levels, are currently not available for this plan. Understanding this deductible is an important factor when estimating your overall healthcare costs with the CommuniCare Advantage ISNP (HMO I-SNP).
Additional Benefits
The CommuniCare Advantage ISNP (HMO I-SNP) offers comprehensive medical coverage featuring no copay for inpatient hospital stays, primary care, and home health services. While many medical services require no copay, patients should expect a standard 10% to 20% coinsurance for outpatient care, specialist visits, diagnostic tests, and ambulance transportation. Emergency care is available with a $100 copay, while urgently needed care carries a 20% coinsurance up to a $40 maximum. This plan also includes valuable supplemental benefits with no copay and no coinsurance, including dental care up to $2,500 annually, hearing services up to $2,000 annually, and vision care up to a $300 annual limit. Additionally, members can take advantage of up to 36 free one-way transportation trips per year and a $150 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
CommuniCare Advantage ISNP (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no copay, although Medicare-defined coinsurance and cost-sharing apply. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers outpatient services with no copays, though coinsurance applies to most of these benefits. Patients will pay a 20% coinsurance for outpatient hospital, observation, substance abuse, and blood services, and a 10% coinsurance for Ambulatory Surgical Center (ASC) services.
Partial Hospitalization See details
CommuniCare Advantage ISNP (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers emergency services with a $100 copay and no coinsurance, and urgently needed services with a 20% coinsurance (maximum $40) and no copay, with cost-sharing waived if admitted to the hospital within three days. 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 ISNP (HMO I-SNP) covers primary care, specialist, mental health, and therapy services with no copay and a 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Chiropractic services are not covered, and routine podiatry visits are limited to 12 per year with no copay and a 20% coinsurance.
Preventive Services See details
CommuniCare Advantage ISNP (HMO I-SNP) offers partially covered preventive services with no copay, though kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and post-welcome visit EKGs require a 20% coinsurance. However, an annual physical exam and additional services—such as fitness benefits, health education, counseling, in-home support, and nutritional programs—are not covered.
Hearing Services See details
Hearing services are partially covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and no coinsurance for routine hearing exams, fitting evaluations, and prescription hearing aids up to a $2,000 annual maximum. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
CommuniCare Advantage ISNP (HMO I-SNP) vision services are partially covered with no copay, no coinsurance, and no deductible, up to a $300 annual maximum. Covered benefits include routine eye exams and eyeglasses (lenses and frames), while contact lenses, individual eyeglass lenses or frames, upgrades, and other eye exam services are not covered.
Dental Services See details
Dental Services are partially covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and no coinsurance up to a $2,500 annual maximum. While most preventive, diagnostic, and comprehensive services are covered, fluoride treatment, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance.
Dialysis Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
CommuniCare Advantage ISNP (HMO I-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment (DME) is subject to a 10% coinsurance, while prosthetic devices, medical supplies, and diabetic equipment and supplies carry a 20% coinsurance.
Diagnostic and Radiological Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers diagnostic and radiological services with no copay and a 20% coinsurance, subject to prior authorization. These covered benefits include diagnostic procedures, lab services, outpatient X-rays, and both diagnostic and therapeutic radiological services.
Home Health Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization. While some services are covered, standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and no coinsurance, as additional days beyond the standard Medicare-covered limit are not covered. Prior authorization is required for these services, which do not require a prior three-day inpatient hospital stay.
Other Services See details
Other services are partially covered under the CommuniCare Advantage ISNP (HMO I-SNP) plan, which features over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $150 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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