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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 $31.40. 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. You must meet this deductible amount out-of-pocket before the plan begins covering your medication costs. Because specific drug tier details and copayments are not available, verifying your prescriptions against the plan's formulary is highly recommended. Evaluating your potential out-of-pocket expenses is a key step in deciding if this Medicare Advantage plan fits your budget. Checking the plan's formulary will help you determine if your medications are covered and what your copay or coinsurance responsibilities will be after meeting the $615 deductible.
Additional Benefits
The CommuniCare Advantage ISNP (HMO I-SNP) offers comprehensive medical coverage with many services requiring no copay and a standard 20% coinsurance. For instance, primary care, outpatient hospital services, and diagnostic tests feature no copay and a 20% coinsurance, though prior authorization is often required. Inpatient hospital stays and home health services are covered with no copay and no coinsurance, while emergency care requires a $100 copay. This plan also includes valuable supplemental benefits, such as dental, vision, and hearing coverage, all featuring no copay and no coinsurance up to specified annual limits. Dental services are covered up to $2,500 annually, hearing services up to $2,000, and vision care up to a $300 yearly maximum with no deductible. Additionally, members can receive up to 36 one-way transportation trips per year and a $150 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required for acute and psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for several of these outpatient services, and there is no deductible for the first three pints of blood.
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, requiring prior authorization. Transportation benefits are partially covered, providing up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, while transport to any health-related location is 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 (up to $40) and no copay, both of which count toward the plan-level deductible. While some worldwide emergency services are covered, 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, psychiatric, podiatry, and opioid treatment services with no copay and 20% coinsurance, though chiropractic services are not covered. Additional telehealth benefits are offered with no copay and no coinsurance, while prior authorization is required for physical, occupational, speech, and opioid treatment services.
Preventive Services See details
CommuniCare Advantage ISNP (HMO I-SNP) partially covers preventive services, offering kidney disease education, glaucoma screenings, and diabetes self-management training with no copay and 20% coinsurance. However, annual physical exams and additional preventive services—including fitness benefits, health education, in-home support, and weight management programs—are not covered.
Hearing Services See details
CommuniCare Advantage ISNP (HMO I-SNP) covers hearing services with no copay, no coinsurance, and no deductible, up to a maximum annual limit of $2,000. While routine exams and fitting evaluations are covered, prescription hearing aids are only partially covered, with OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids excluded from coverage.
Vision Services See details
CommuniCare Advantage ISNP (HMO I-SNP) partially covers vision services with no copay, no coinsurance, and no deductible, up to a $300 yearly maximum. Covered benefits include routine eye exams and eyeglasses (lenses and frames), while contact lenses, individual eyeglass lenses, individual eyeglass 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 a maximum annual benefit of $2,500. While many preventive and comprehensive services are covered, fluoride treatment, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by CommuniCare Advantage ISNP (HMO I-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 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 durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for all of these covered medical equipment services.
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. This coverage applies to all diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by CommuniCare Advantage ISNP (HMO I-SNP) 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 required, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services 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 Medicare-defined coinsurance, as additional days beyond the Medicare-covered limit are not covered. Prior authorization is required for these services, though a prior three-day inpatient hospital stay is not required.
Other Services See details
Other Services are partially covered by CommuniCare Advantage ISNP (HMO I-SNP), which features over-the-counter (OTC) items with no copay and no coinsurance up to a $150 maximum limit every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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