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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 $31.20. 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) prescription drug plan features an annual drug deductible of $615. This deductible is the amount you must pay out-of-pocket for covered medications before the plan begins to pay its share. Understanding this upfront cost is essential when evaluating your overall Medicare drug coverage and healthcare budget. While specific drug coverage tier details, including exact copayments and coinsurance, are not currently available, the $615 deductible is the key cost factor to consider. To find out how your specific prescriptions are covered under this plan, you will need to review the plan's formulary. This ensures you have the most accurate estimate of your potential medication expenses.
Additional Benefits
The CommuniCare Advantage ISNP (HMO I-SNP) plan offers comprehensive medical coverage with no copays for inpatient hospital stays, doctor visits, and outpatient care, though a 20% coinsurance and Medicare-defined deductibles typically apply. Emergency room visits require a $100 copay, while urgent care services are subject to a 20% coinsurance up to $40. Skilled nursing facility care, home health care, and home infusion services are also available with no copay and no coinsurance, though prior authorization is required for most of these medical services. For extra wellness support, the plan provides dental care up to a $2,500 annual limit and vision services up to a $300 annual limit with no copay and no coinsurance. Beneficiaries also receive hearing care up to a $2,000 annual maximum, a $200 over-the-counter allowance every three months, and up to 36 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance. These additional benefits help reduce out-of-pocket costs for essential daily health and wellness needs.
Inpatient Hospital See details
CommuniCare Advantage ISNP (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services with no copay, though Medicare-defined coinsurance and deductibles apply and prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copays and a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization is covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required for some of these services.
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, subject to prior authorization. Transportation services to plan-approved health-related locations are covered with no copay or coinsurance for up to 36 one-way trips per year, 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 $100.00 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40.00 per visit) and no copay, with both cost shares counting toward the plan-level deductible. 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, therapy, mental health, podiatry, and psychiatric services with no copay and 20% coinsurance. Additional telehealth benefits are available with no copay and no coinsurance, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are partially covered by CommuniCare Advantage ISNP (HMO I-SNP), offering Medicare-covered zero-dollar preventive services, kidney education, and select screenings with no copay and a 20% coinsurance. However, annual physical exams and all additional preventive services—including fitness benefits, health education, in-home safety assessments, and weight management programs—are not covered.
Hearing Services See details
CommuniCare Advantage ISNP (HMO I-SNP) partially covers hearing services, offering routine exams, fittings, and select prescription hearing aids with no copay, no coinsurance, and no deductible up to a $2,000 annual maximum. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and no coinsurance up to a $300 annual limit. This benefit partially covers routine eye exams and complete eyeglasses (lenses and frames), but contact lenses, individual lenses, individual frames, upgrades, and other eye exam services are not covered.
Dental Services See details
CommuniCare Advantage ISNP (HMO I-SNP) offers partially covered dental services with no copay and no coinsurance up to an annual maximum of $2,500. While most diagnostic, preventive, and comprehensive services are covered at no cost, 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 and no coinsurance, though prior authorization is required. Under this coverage, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
CommuniCare Advantage ISNP (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and 20% coinsurance. Prior authorization is required for these benefits, and there are no restricted manufacturers or preferred vendors.
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. Covered benefits include Medicare-covered diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
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) indicates some services are covered for Cardiac Rehabilitation Services with no copay and prior authorization required. However, specific sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered by the plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered under this plan.
Other Services See details
CommuniCare Advantage ISNP (HMO I-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $200 limit every three months. Acupuncture, meal benefits, Nicotine Replacement Therapy, and Naloxone are not covered.
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