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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 $41.00. 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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. The copays range from $10 to $95, or 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for your Part D covered drugs.
Additional Benefits
The CommuniCare Advantage Emerald (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and partial hospitalization. The plan also covers ambulance services, emergency services, and primary care with no copays for primary care visits. Additional benefits include coverage for preventive, hearing, vision, dental, and home infusion services. The plan also covers skilled nursing facility services with no copay for the first 20 days and a $196 copay for days 21-40, and offers an over-the-counter benefit and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you will pay a $310 copay for days 1-5, and no copay for days 6-90. For psychiatric care, you will pay a $310 copay for days 1-5, and no copay for days 6-90. Additional days for both acute and psychiatric care, and non-Medicare-covered stays, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $400, observation services with a $400 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $40 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the CommuniCare Advantage Emerald (HMO) plan. This benefit has a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CommuniCare Advantage Emerald (HMO) plan. Ground ambulance services have a $220 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location 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 and Worldwide Emergency Coverage have a $95 copay, and Urgently Needed Services have a $45 copay, with no coinsurance for any of these services. 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 with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $35 copay, and physician specialist services have a $50 copay. Mental health specialty services, including individual and group sessions, are covered with no copay for individual sessions and a $15 copay for group sessions. Podiatry services, other health care professional services, and psychiatric services have varying copays, and physical therapy and speech-language pathology services have a $40 copay. The plan also covers additional telehealth benefits and opioid treatment program services.
Preventive Services See details
The CommuniCare Advantage Emerald (HMO) plan covers preventive services, but does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services. Kidney disease education services have a $10 copay, while glaucoma screening and diabetes self-management training have a 10% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids with no copay, coinsurance, or deductible. Prescription hearing aids are covered with a copay between $100 and $350, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services, including routine eye exams and eyewear, are covered under the CommuniCare Advantage Emerald (HMO) plan. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The CommuniCare Advantage Emerald (HMO) plan covers dental services, with a maximum benefit of $2,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered, while 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. For Medicare Part B Insulin Drugs, there is a $35 copay, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the CommuniCare Advantage Emerald (HMO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The CommuniCare Advantage Emerald (HMO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered items, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests and outpatient X-ray services, with copays ranging from $0 to $50 for procedures/tests, $40 for X-rays, and up to $200 for diagnostic radiological services. Therapeutic radiological services have a $60 copay, while lab services are not covered.
Home Health Services See details
Home Health Services are covered by the CommuniCare Advantage Emerald (HMO) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. 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 offers an Over-the-Counter (OTC) benefit with a maximum of $50 every three months, and a Meal Benefit requiring a doctor's referral. 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 are not covered.
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