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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 2025, 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 2025.
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) has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs at a standard pharmacy, you will pay a $7 copay for preferred generics and a $30 copay for standard generics. For brand name drugs, you will pay 25% coinsurance at either a preferred or standard pharmacy. After your total drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Community First Medicare Advantage Alamo Plan (HMO) offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a $175 copay for days 1-6, and no copay for days 7-90. Outpatient services, such as outpatient hospital and substance abuse services, are covered with varying copays. The plan also provides coverage for ambulance services, emergency services, and primary care with copays ranging from $0-$20. Additional benefits include hearing exams with a $25 copay, vision services with a $25 copay for eye exams, and dental services with a $15 copay for Medicare dental services. This plan also covers home health services with no copay, and offers an OTC allowance of $175 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered with a $175 copay for days 1-6, and no copay for days 7-90. Additional days for both acute and psychiatric services are covered, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $175 copay and 20% coinsurance, observation services with a $175 copay, ambulatory surgical center services with a $175 copay, and outpatient substance abuse services with a $30 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Community First Medicare Advantage Alamo Plan (HMO) with a $45 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Community First Medicare Advantage Alamo Plan (HMO). Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation Services - Any Health-related Location is covered for 70 one-way trips every year, and other transportation services are 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. Urgently Needed Services are also covered, with a $25 copay and no coinsurance, but Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Community First Medicare Advantage Alamo Plan (HMO) covers primary care physician services and specialist services with copays of $0-$20, occupational therapy with a $30 copay, and physical therapy and speech-language pathology services with a $25-$30 copay. Chiropractic services have a $20 copay, and individual and group sessions for mental health and psychiatric services have a $15 or $40 copay. Additional telehealth benefits have a $0-$25 copay, and Opioid Treatment Program Services are covered. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Community First Medicare Advantage Alamo Plan (HMO) covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. The plan does not cover health education, in-home safety assessments, 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, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services. The plan covers personal emergency response systems, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and fitness benefits (Memory Fitness).
Hearing Services See details
Hearing services include coverage for hearing exams with a $25 copay. Prescription hearing aids are covered up to a maximum of $3500 per year for all types of hearing aids except for inner ear, outer ear, and over the ear aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $25 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, with a $25 copay for contact lenses, and a combined maximum benefit of $300 per year.
Dental Services See details
The Community First Medicare Advantage Alamo Plan (HMO) covers dental services, including a $15 copay for Medicare dental services. Other covered dental services include oral exams (2 visits per year), dental X-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventive dental services, and orthodontics with a maximum plan benefit of $2,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Community First Medicare Advantage Alamo Plan (HMO), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services not covered. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services have a copay of at most $50, while Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Community First Medicare Advantage Alamo Plan (HMO), with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community First Medicare Advantage Alamo Plan (HMO). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Community First Medicare Advantage Alamo Plan (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $170. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Community First Medicare Advantage Alamo Plan (HMO) covers Over-the-Counter (OTC) Items with a maximum benefit of $175 every three months, and Meal Benefits with prior authorization. Acupuncture, 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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