A non-government entity
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 2026, 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 2026.
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 $16.20. 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 $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:
Sign up for Sentara Community Complete (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Sentara Community Complete (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Knowing this yearly deductible is a key factor when calculating your overall healthcare costs. Specific drug coverage tier details, such as copays and coinsurance for different medication tiers, are not available for this plan. To determine your exact costs for specific prescriptions, you should consult the plan's formulary or contact the provider directly.
Additional Benefits
Sentara Community Complete (HMO D-SNP) offers robust coverage with no copays for most medical services, though many outpatient and specialist visits require a 20% coinsurance. Key benefits such as inpatient hospital stays, home health services, and skilled nursing facility care are covered with no copay and no coinsurance. This plan also provides generous allowances for supplemental care, including dental services up to $4,000 annually and prescription hearing aids up to $2,000 with no copay and no coinsurance. Members also receive a $400 monthly over-the-counter reimbursement and up to 40 one-way transportation trips to approved health-related locations with no copay and no coinsurance.
Inpatient Hospital See details
Sentara Community Complete (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance and no copay, though prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered by this plan.
Outpatient Services See details
Sentara Community Complete (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copays and a 20% coinsurance. Prior authorization is required for these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Sentara Community Complete (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Sentara Community Complete (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services to plan-approved health-related locations are covered with no copay and no coinsurance for up to 40 one-way trips per year, though transportation to any health-related location is not covered.
Emergency Services See details
Sentara Community Complete (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within 24 hours. Emergency service costs count toward your plan-level deductible, and worldwide emergency, urgent, and transportation services are covered up to $100,000 with no copay and no coinsurance.
Primary Care See details
Sentara Community Complete (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, though prior authorization is typically required. Chiropractic benefits are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Sentara Community Complete (HMO D-SNP) covers preventive services, including an annual physical exam with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, excluding in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, caregiver support, and counseling. Kidney disease education, diabetes self-management, glaucoma screenings, and digital rectal exams are covered with no copay and a 20% coinsurance.
Hearing Services See details
Sentara Community Complete (HMO D-SNP) covers hearing services, including one annual routine hearing exam with no copay and 20% coinsurance, and three fitting evaluations. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 annual limit, though inner ear, outer ear, and over-the-ear prescription models, as well as OTC hearing aids, are not covered.
Vision Services See details
Sentara Community Complete (HMO D-SNP) covers routine eye exams and eyewear with no copay and a 20% coinsurance, up to a $400 annual combined maximum. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Sentara Community Complete (HMO D-SNP) partially covers dental services with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a 20% coinsurance and no copay. There is a $4,000 annual maximum for comprehensive services, but other diagnostic, other preventive, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Sentara Community Complete (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Sentara Community Complete (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Sentara Community Complete (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Sentara Community Complete (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home health services are covered under the Sentara Community Complete (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Sentara Community Complete (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, a 20% coinsurance, and prior authorization required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Sentara Community Complete (HMO D-SNP) partially covers skilled nursing facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While the plan allows admission without a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Sentara Community Complete (HMO D-SNP) partially covers other services, offering an Over-the-Counter (OTC) benefit with no copay and no coinsurance up to $400 per month via reimbursement. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved