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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 $39.30. 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 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, your Part D premium may be reduced to $39.30. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The CommuniCare Advantage ISNP (HMO I-SNP) plan offers a range of benefits with varying cost-sharing. Many services, like primary care, outpatient services, and dental, include coinsurance, often at 20%. Emergency services have a $100 copay, and ambulance services have a 20% coinsurance. This plan covers a wide array of services, including hearing, vision, and dental, with specific limitations on coverage for certain items like contact lenses and prescription hearing aids. It also offers additional benefits such as home health services with no copay, transportation, and an OTC allowance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare covered stays, and upgrades are not covered for either. Both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric require prior authorization and have coinsurance, with the plan charging the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and outpatient blood services have a 20% coinsurance, while ambulatory surgical center (ASC) services and outpatient substance abuse services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the CommuniCare Advantage ISNP (HMO I-SNP) plan and 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. Ground and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for 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 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, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Occupational Therapy and Physical Therapy and Speech-Language Pathology Services have no coinsurance or copay.
Preventive Services See details
Preventive Services are covered by the CommuniCare Advantage ISNP (HMO I-SNP) plan. Some services have a 20% coinsurance, including Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, while the Annual Physical Exam, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, all of which are covered with no deductible. Prescription hearing aids are covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams with no copay, and a maximum benefit of $250. Eyewear benefits are covered, but contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CommuniCare Advantage ISNP (HMO I-SNP) plan covers a maximum of $2,000 per year for dental services, including oral exams, dental x-rays, other diagnostic services, cleanings, other preventive services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. 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 (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under this plan. DME has a 20% coinsurance, while Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts each have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the CommuniCare Advantage ISNP (HMO I-SNP) plan, with no copay for all services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also 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, 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 this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required for SNF services.
Other Services See details
The "Other Services" benefit covers Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $150 every three months. However, acupuncture, meal benefits, and several other services are not covered.
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