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CommuniCare Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CommuniCare Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CommuniCare Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
CommuniCare Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Community Health Group available for enrollment in 2025 to people living in San Diego County California. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that CommuniCare Advantage (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:
CommuniCare Advantage (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 CommuniCare Advantage (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 CommuniCare Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 CommuniCare Advantage (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. This means you must pay this amount out-of-pocket before the plan begins to cover costs. After the deductible, you will pay a certain amount for your drugs until your total drug costs reach $2000.00. If you qualify for the low-income subsidy (LIS), your Part D premium is $29.70. Once your yearly out-of-pocket drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The CommuniCare Advantage (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. You'll find coverage for ambulance services, emergency services, and transportation to health-related locations. The plan also includes vision and dental coverage, with an annual maximum for dental services. Additional benefits include home health services with no copay, medical equipment, and diagnostic services, all with coinsurance requirements. This plan also provides coverage for hearing exams, and offers an allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered. For covered services, you may have to pay the Medicare-defined cost share.
Outpatient Services See details
Outpatient services are covered by CommuniCare Advantage (HMO D-SNP), including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital and observation services have a 20% coinsurance, while individual and group sessions for outpatient substance abuse have a minimum of 20% and a maximum of 20% coinsurance; outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CommuniCare Advantage (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 48 one-way rides per year via rideshare services. 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 (HMO D-SNP) plan, each with a 20% coinsurance and no copay, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered. The coinsurance for emergency services is waived if admitted to the hospital within 3 days, and the maximum per-visit amount is $110 for emergency services and $45 for urgently needed services.
Primary Care See details
Under the CommuniCare Advantage (HMO D-SNP) plan, primary care physician services are covered with a coinsurance between 0% and 20%, chiropractic services are covered with a 20% coinsurance, and occupational therapy services are covered with a 20% coinsurance. Physician specialist services, physical therapy, and speech-language pathology services are covered with a 20% coinsurance. Mental health specialty services, individual sessions for mental health specialty services, group sessions for mental health specialty services, individual sessions for psychiatric services, group sessions for psychiatric services, and opioid treatment program services are covered with a minimum coinsurance of 20% and a maximum coinsurance of 20%. Other health care professional services are covered with a coinsurance of 20%. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, but 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, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have a 20% coinsurance. Additional preventive services require prior authorization and a doctor referral.
Hearing Services See details
Hearing Services are partially covered by the CommuniCare Advantage (HMO D-SNP) plan. Hearing exams are covered with a coinsurance of at most 20%, but routine hearing exams are not covered. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance, as well as contact lenses and eyeglasses (lenses and frames). Routine eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered. There is a combined maximum plan benefit coverage amount of $500 per year for eyewear.
Dental Services See details
The CommuniCare Advantage (HMO D-SNP) plan covers dental services, with a $2,500 annual maximum. Medicare Dental Services have a 20% coinsurance. Other Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. The copay for Medicare Part B Insulin Drugs is $35, and the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the CommuniCare Advantage (HMO D-SNP) plan, and a doctor referral is required. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the CommuniCare Advantage (HMO D-SNP) plan, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with 20% coinsurance for Medicare-covered supplies and therapeutic shoes. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the CommuniCare Advantage (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by CommuniCare Advantage (HMO D-SNP) with no copay or coinsurance, but additional hours of care and personal care services are not covered. Both a referral and authorization are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the CommuniCare Advantage (HMO D-SNP) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The CommuniCare Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $200 every three months, including nicotine replacement therapy and naloxone coverage. 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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