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Sentara Community Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sentara Community Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sentara Community Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Sentara Community Complete (HMO D-SNP) is a HMO D-SNP plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in Statewide. The overall rating for this plan is not yet available for 2025.
It's important to know that Sentara Community Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Sentara Community Complete (HMO D-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 Sentara Community Complete (HMO D-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 Sentara Community Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.20. 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 $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 Sentara Community Complete (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you'll pay $27.20 for Part D.
Additional Benefits
The Sentara Community Complete (HMO D-SNP) plan offers a range of benefits, including coverage for outpatient services, emergency services, and primary care with a 20% coinsurance. The plan also covers preventive services, such as annual physical exams and additional services like health education, some with a 20% coinsurance. In addition to medical services, the plan includes coverage for hearing, vision, and dental services, with a 20% coinsurance for most services, as well as coverage for medical equipment and home health services, all with a 20% coinsurance. Additionally, the plan offers transportation to health-related locations, over-the-counter items, and covers home infusion bundled services with a $35 copay for some drugs and coinsurance for others.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the specific copay information is not available in this summary. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, substance abuse services, and blood services, are covered by the Sentara Community Complete (HMO D-SNP) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Individual and Group Sessions for Outpatient Substance Abuse have a coinsurance between 20% and 20%. Outpatient Blood Services also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including Ground and Air Ambulance Services, each with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 60 one-way trips per year, using rideshare services, bus/subway, medical transport, or other modes of transportation.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a maximum benefit coverage of $50,000.
Primary Care See details
The Sentara Community Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. For primary care physician services, physician specialist services, physical therapy, and speech-language pathology services, the plan has a 20% coinsurance. Chiropractic services, podiatry services, and psychiatric services have a 20% coinsurance for individual sessions, and group sessions.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, annual physical exams, and additional preventive services like health education, personal emergency response systems, re-admission prevention, nutritional/dietary benefits, in-home support services, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, remote access technologies, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following Welcome Visits. Kidney disease education services, Glaucoma Screening, and Diabetes Self-Management Training have a 20% coinsurance. In-home safety assessments, medical nutrition therapy, post discharge in-home medication reconciliation, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers of enrollees, counseling services, and telemonitoring services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of 20%, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $2,000 every year, but not prescription hearing aids for the inner ear, outer ear, or over the ear. The plan does not cover OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, is covered with a 20% coinsurance, and there is a combined maximum of $400 per year, while eyeglass lenses and frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, and oral and maxillofacial surgery. Orthodontic services are covered up to a maximum of $4,000 per year, while maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Sentara Community Complete (HMO D-SNP) plan and require prior authorization. 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 under the Sentara Community Complete (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts, each with a 20% coinsurance; Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Sentara Community Complete (HMO D-SNP) plan. All diagnostic services have no copay and coinsurance applies, and all radiological services have no copay and coinsurance applies.
Home Health Services See details
Home Health Services are covered by the Sentara Community Complete (HMO D-SNP) plan with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Sentara Community Complete (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with a maximum benefit of $200 every three months, while acupuncture, meal benefits, 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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