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CommuniCare Advantage Emerald (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CommuniCare Advantage Emerald (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CommuniCare Advantage Emerald (HMO) in 2025, please refer to our full plan details page.
CommuniCare Advantage Emerald (HMO) is a HMO plan offered by SNP Holdings, LLC available for enrollment in 2025 to people living in Indiana, Maryland, Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that CommuniCare Advantage Emerald (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about CommuniCare Advantage Emerald (HMO).
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 Emerald (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 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 Emerald (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for generic and brand-name drugs. For preferred generics, the copay is $10 at standard and mail-order pharmacies. The copay is $45 for standard generics, and $95 for preferred brand drugs. Non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The CommuniCare Advantage Emerald (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay of $370 for the first five days, and then no copay for the remainder. Outpatient services, primary care, preventive services, hearing, vision, dental, and home health services are also covered, some with no copay, while others have copays, coinsurance, or annual maximums. This plan also includes coverage for emergency services, ambulance, and transportation, with associated copays. Additionally, the plan covers partial hospitalization, skilled nursing facility stays, home infusion, dialysis, medical equipment, and diagnostic services. This plan also offers an over-the-counter benefit and a meal benefit with a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital coverage requires prior authorization and has a copay of $370 for days 1-5, and a copay of $0 for days 6-90. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $25. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the CommuniCare Advantage Emerald (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CommuniCare Advantage Emerald (HMO) plan. Medicare-covered ground and air ambulance services have a $250 copay, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the CommuniCare Advantage Emerald (HMO) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $95 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The CommuniCare Advantage Emerald (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $20 copay, physician specialist services with a $30 copay, mental health specialty services, podiatry services with a $30 copay for routine foot care, other health care professional services with a $50 copay, psychiatric services, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care is not covered.
Preventive Services See details
The CommuniCare Advantage Emerald (HMO) plan covers preventive services including Medicare-covered preventive services, with no copay. Some additional preventive services are not covered, and others like Kidney Disease Education Services have a $10 copay. Other preventive services like Glaucoma Screening and Diabetes Self-Management Training have a 10% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay or coinsurance. Prescription hearing aids are covered up to a maximum of $4,000 every three years, with a copay between $100 and $350, but prescription hearing aids for the inner, outer, and 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, eyewear, and contact lenses. The plan does not have a deductible for any of these services, but the plan covers up to $350 per year for eye exams. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CommuniCare Advantage Emerald (HMO) plan offers dental services with a $2,000 annual maximum. The plan covers 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, but does not cover fluoride treatment, adjunctive general services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 under the CommuniCare Advantage Emerald (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the CommuniCare Advantage Emerald (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies are covered with no copay, and a 20% coinsurance applies for Medicare-covered items. Diabetic Equipment is covered, with a coinsurance for Medicare-covered supplies, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the CommuniCare Advantage Emerald (HMO) plan. Diagnostic Procedures/Tests have a copay of $30, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $170, Therapeutic Radiological Services have a minimum copay of $60, and Outpatient X-Ray Services have a copay of $25.
Home Health Services See details
Home Health Services are covered by the CommuniCare Advantage Emerald (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CommuniCare Advantage Emerald (HMO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the CommuniCare Advantage Emerald (HMO) plan, with prior authorization required. For days 1-20, there is no copay, for days 21-40 the copay is $196, and for days 41-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The CommuniCare Advantage Emerald (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, but does not cover Acupuncture, 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 also covers a Meal Benefit with a doctor's referral.
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