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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 $46.30. 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 $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs, but the exact cost depends on the drug tier and the pharmacy you use. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced premium.
Additional Benefits
The CommuniCare Advantage ISNP (HMO I-SNP) plan offers coverage for a range of services with varying cost-sharing. Inpatient hospital stays are covered with the standard Medicare cost share, while outpatient services and partial hospitalization require a 20% coinsurance. Emergency services have a $100 copay, and ambulance services have a 20% coinsurance. The plan also includes benefits for primary care, preventive services, hearing, vision, and dental. Hearing services include hearing exams and hearing aids, and vision services cover routine eye exams and eyeglasses. Dental services have a $2,000 annual maximum benefit. The plan also covers medical equipment, diagnostic and radiological services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the CommuniCare Advantage ISNP (HMO I-SNP) plan, but additional days and non-Medicare-covered stays are not covered. For inpatient hospital services, you will pay the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered, with a coinsurance of 20%. Outpatient Blood Services are covered with a 20% coinsurance, and the plan waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered under the CommuniCare Advantage ISNP (HMO I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ambulance services, but a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for 36 one-way trips per year. Transportation services to any health-related location are not covered.
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 have a 20% coinsurance and no copay, and 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 and 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, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan. 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 includes coverage for hearing exams with a maximum benefit of $2,000 every year, as well as Routine Hearing Exams and Fitting/Evaluation for Hearing Aid, both of which are unlimited. Prescription Hearing Aids (all types) are covered, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and a maximum plan benefit of $250 every year. 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 benefit. 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. However, 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 20% coinsurance and requires authorization, and 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 and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered stays and non-Medicare-covered stays are not covered. Prior authorization is required for SNF services.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, but does not cover 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. The plan offers up to $200 every three months for OTC items.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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