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Community First Medicare Advantage Alamo Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community First Medicare Advantage Alamo Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community First Medicare Advantage Alamo Plan (HMO) in 2026, please refer to our full plan details page.
Community First Medicare Advantage Alamo Plan (HMO) is a HMO plan offered by Bexar County Hospital District available for enrollment in 2025 to people living in Bexar County. The overall rating for this plan is not yet available for 2026.
It's important to know that Community First Medicare Advantage Alamo Plan (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 Community First Medicare Advantage Alamo Plan (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 Community First Medicare Advantage Alamo Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 a $200.00 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 $3500.00 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 Community First Medicare Advantage Alamo Plan (HMO) features an annual prescription drug deductible of $200. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require standard copays of $5.00 for a one-month supply, $10.00 for a two-month supply, and $12.50 for a three-month supply. For Tier 3 preferred brand drugs, standard pharmacy and mail order copays range from $47.00 for a one-month supply up to $117.50 for a three-month supply. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 25% coinsurance for all supply lengths. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The Community First Medicare Advantage Alamo Plan (HMO) offers robust medical coverage with no copay for primary care visits, preventive care, and home health services. Inpatient hospital stays require a $170 daily copay for the first six days, while outpatient services carry a $175 copay and emergency room visits feature a $90 copay. Additionally, members can access up to 50 one-way trips to health-related destinations each year with no copay. This plan also features strong supplemental benefits, including preventive and comprehensive dental care with no copay up to a $1,500 annual limit. Routine vision and hearing exams require a $25 copay, with prescription hearing aids covered up to $3,500 annually with no copay. Durable medical equipment is available with a 20% coinsurance and no copay, and members receive a $155 over-the-counter allowance every three months.
Inpatient Hospital See details
Community First Medicare Advantage Alamo Plan (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $170 daily copay for days 1 to 6 and no copay for days 7 to 90. Prior authorization is required, and while unlimited additional days are covered, room upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community First Medicare Advantage Alamo Plan (HMO) covers outpatient hospital services with a $175 copay and 20% coinsurance, and ambulatory surgical center services with a $175 copay and no coinsurance. Outpatient substance abuse services require a $30 copay and no coinsurance for individual or group sessions, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Community First Medicare Advantage Alamo Plan (HMO) covers partial hospitalization services with a $45 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Community First Medicare Advantage Alamo Plan (HMO), with ground ambulance services requiring a $250 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Additionally, the plan offers up to 50 one-way trips per year to any health-related location with no copay and no coinsurance, though transportation to plan-approved locations is not covered.
Emergency Services See details
Emergency services are covered under the Community First Medicare Advantage Alamo Plan (HMO) with a $90 copay and no coinsurance, and urgently needed services are covered with a $25 copay and no coinsurance. Although some worldwide emergency services are covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Community First Medicare Advantage Alamo Plan (HMO) covers primary care physician visits and opioid treatment with no copay and no coinsurance. Specialist visits, mental health, psychiatric, and physical therapy services are covered with copays ranging from $15 to $30 and no coinsurance, while podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by the Community First Medicare Advantage Alamo Plan (HMO) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and memory fitness. However, several supplemental services are not covered, including health education, weight management programs, alternative therapies, and in-home safety assessments.
Hearing Services See details
Hearing Services are partially covered by the Community First Medicare Advantage Alamo Plan (HMO), offering annual routine exams and fittings for a $25 copay and no coinsurance. Prescription hearing aids are covered up to a $3,500 annual maximum with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by the Community First Medicare Advantage Alamo Plan (HMO), which offers routine eye exams and eyewear for a $25 copay and no coinsurance, up to a $300 annual limit. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Community First Medicare Advantage Alamo Plan (HMO) covers preventive and comprehensive dental services with no copay and no coinsurance up to a $1,500 annual maximum. Medicare-covered dental services are also available for a $15 copay and no coinsurance.
Home Infusion bundled Services See details
Community First Medicare Advantage Alamo Plan (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, feature no coinsurance up to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by the Community First Medicare Advantage Alamo Plan (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by the Community First Medicare Advantage Alamo Plan (HMO), with durable medical equipment, prosthetics, and medical supplies requiring no copay and a 20% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the Community First Medicare Advantage Alamo Plan (HMO) with no coinsurance, though prior authorization is required. There is no copay for diagnostic services and diagnostic radiological services, while therapeutic radiological services have a minimum copay of $50.00, and diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Community First Medicare Advantage Alamo Plan (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access these services.
Cardiac Rehabilitation Services See details
Community First Medicare Advantage Alamo Plan (HMO) notes that some services are covered for Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These non-covered services require copayments of $30 for cardiac rehabilitation, $35 for intensive cardiac rehabilitation, $15 for pulmonary rehabilitation, and $25 for SET for PAD.
Skilled Nursing Facility (SNF) See details
Community First Medicare Advantage Alamo Plan (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $170 daily copay for days 21 through 100. Prior authorization and a three-day inpatient hospital stay are required prior to admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Community First Medicare Advantage Alamo Plan (HMO) with no copay and no coinsurance for chronic illness meals and over-the-counter item reimbursements up to $155 every three months. Acupuncture and nicotine replacement therapy are not covered, and meal benefits require prior authorization.
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