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Community First Medicare Advantage D-SNP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community First Medicare Advantage D-SNP (HMO D-SNP). 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 D-SNP (HMO D-SNP) in 2026, please refer to our full plan details page.
Community First Medicare Advantage D-SNP (HMO D-SNP) is a HMO D-SNP plan offered by Bexar County Hospital District available for enrollment in 2025 to people living in South Texas. The overall rating for this plan is not yet available for 2026.
It's important to know that Community First Medicare Advantage D-SNP (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:
Community First Medicare Advantage D-SNP (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 Community First Medicare Advantage D-SNP (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 Community First Medicare Advantage D-SNP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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:
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Drug Coverage
The Community First Medicare Advantage D-SNP (HMO D-SNP) has an annual prescription drug deductible of $615. For Tier 1 preferred generic medications, the plan offers no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. For Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for all supply lengths at standard pharmacies and standard mail order. Additionally, Tier 5 specialty drugs require a 25% coinsurance for a one-month supply through standard pharmacies or standard mail-order options.
Additional Benefits
The Community First Medicare Advantage D-SNP (HMO D-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for inpatient hospital stays and home health services. Most outpatient services, primary care visits, specialist consultations, and emergency care require no copay but are subject to a 20% coinsurance. Additionally, the plan covers up to 55 one-way transportation trips per year to health-related locations with no copay and no coinsurance. Ancillary benefits include preventive and comprehensive dental care covered up to a $2,000 annual limit with no copay and no coinsurance. Vision and hearing benefits are also highly accessible, offering prescription hearing aids up to $4,000 annually and eyewear up to $375 with no copay. Eligible members can also access over-the-counter items and chronic illness meals with no copay and no coinsurance, helping to further reduce out-of-pocket healthcare expenses.
Inpatient Hospital See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers outpatient services with no copays, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers partial hospitalization with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Community First Medicare Advantage D-SNP (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance (waived if admitted) but no copay. Transportation to any health-related location is also covered for up to 55 one-way trips per year with no copay and no coinsurance, though prior authorization is required and plan-approved health-related location transportation is not covered.
Emergency Services See details
Emergency services are covered by Community First Medicare Advantage D-SNP (HMO D-SNP) with a 20% coinsurance and no copay up to a maximum of $115 per visit, while urgently needed services require a 20% coinsurance and no copay up to a maximum of $40 per visit. Worldwide emergency services, including worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation, are not covered.
Primary Care See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, telehealth, and opioid treatment services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan, and prior authorization is required for physical, occupational, and speech therapy.
Preventive Services See details
Preventive services are partially covered by Community First Medicare Advantage D-SNP (HMO D-SNP), featuring no copay and no coinsurance for Medicare-covered zero-dollar services, memory fitness, and PERS. Kidney education and specific screenings require a 20% coinsurance with no copay, while annual physical exams, health education, in-home safety assessments, medical nutrition therapy, and alternative therapies are not covered.
Hearing Services See details
Hearing services through the Community First Medicare Advantage D-SNP (HMO D-SNP) are partially covered, offering hearing exams with no copay but requiring a 20% coinsurance for routine annual visits. Prescription hearing aids are covered with no copay or coinsurance up to a $4,000 annual limit, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Community First Medicare Advantage D-SNP (HMO D-SNP) partially covers vision services with no deductibles, offering one routine eye exam per year with no copay and a 20% coinsurance, while other eye exam services are not covered. Eyewear is covered up to a $375 yearly limit with no copay, requiring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses, though upgrades are excluded.
Dental Services See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance. Preventive and comprehensive dental services, including cleanings, x-rays, and implants, are covered with no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy and insulin, are covered with coinsurance ranging from 0% to 20%, with insulin also requiring a $35 copay that counts toward the plan deductible.
Dialysis Services See details
Dialysis Services are covered by Community First Medicare Advantage D-SNP (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, but there are no preferred vendor or manufacturer restrictions.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Community First Medicare Advantage D-SNP (HMO D-SNP) with no copay and a 20% coinsurance, with prior authorization required. This benefit includes diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Community First Medicare Advantage D-SNP (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Community First Medicare Advantage D-SNP (HMO D-SNP) with no copay, but require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Community First Medicare Advantage D-SNP (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and Medicare-defined coinsurance, though prior authorization is required. The benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered and a prior three-day inpatient hospital stay is required for admission.
Other Services See details
Other services are partially covered by Community First Medicare Advantage D-SNP (HMO D-SNP), which excludes acupuncture but covers over-the-counter items and chronic illness meals with no copay and no coinsurance. The over-the-counter benefit provides up to $50 every three months via reimbursement, while the meal benefit requires prior authorization.
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