CommuniCare Advantage (HMO D-SNP)

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 3.5 out of 5 stars in 2026.

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.

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.

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:

Drug Coverage

The CommuniCare Advantage (HMO D-SNP) plan features an annual prescription drug deductible of $615.00, which may be paired with a reduced Part D premium of $12.00 for members who qualify for the LIS Full subsidy. After meeting this deductible, you will enter the initial coverage phase and pay a 25% coinsurance for Tier 1 through Tier 4 drugs at standard pharmacies, or a 15% coinsurance for Tier 5 specialty drugs. These cost-sharing rates remain in effect until your total drug costs reach $2,100.00. Once your yearly out-of-pocket costs reach the $2,100.00 limit, you enter the catastrophic coverage phase and will have no copay for Medicare Part D covered drugs. This ensures you pay nothing for your covered prescriptions for the rest of the calendar year. Be sure to review the plan's formulary to confirm the specific coverage tiers for your prescription medications.

Additional Benefits

CommuniCare Advantage (HMO D-SNP) offers comprehensive medical coverage featuring no copays and a standard 20% coinsurance for most outpatient, emergency, diagnostic, and dialysis services. Inpatient hospital stays and skilled nursing facility care are partially covered with no plan copay, subject to Medicare-defined coinsurance. Primary care visits and preventive services are also available with no copay, and select preventive benefits include an $800 annual home safety modification allowance. The plan provides robust dental benefits with no copay or coinsurance for preventive and comprehensive care up to a $2,500 yearly limit, alongside vision coverage that includes no copay and a $500 annual eyewear allowance. Members also benefit from a $200 quarterly over-the-counter allowance and up to 12 one-way trips for plan-approved transportation. While home health services feature no copays or coinsurance, other services like routine hearing exams and cardiac rehabilitation are not covered under this plan.