A non-government entity
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 2025, 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 2025.
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 $18.30. 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 $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 $9150.00 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:
Sign up for Community First Medicare Advantage D-SNP (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Community First Medicare Advantage D-SNP (HMO D-SNP) plan has a $590 deductible for prescription drugs. During the initial coverage phase, you'll pay coinsurance for your medications. The coinsurance is 25% of the cost of the drug, regardless of the tier or pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly premium will be $18.30.
Additional Benefits
The Community First Medicare Advantage D-SNP (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with coinsurance typically set at 20%. The plan also covers primary care, preventive services, and home health services, with no copay for some services. Additional benefits include coverage for hearing, vision, and dental services, with specific copays and annual limits. The plan provides coverage for ambulance services with no copay, and also covers medical equipment, diagnostic services, and home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Community First Medicare Advantage D-SNP (HMO D-SNP) plan, but additional days, non-Medicare covered stays, and upgrades for acute and psychiatric hospitalizations are not covered. The plan's coinsurance follows original Medicare guidelines.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance Services are covered with no copay, but require prior authorization and have a 20% coinsurance for both ground and air ambulance services, which is waived if admitted to the hospital. Transportation Services are partially covered, with 75 one-way trips per year to any health-related location.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Community First Medicare Advantage D-SNP (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
The Community First Medicare Advantage D-SNP (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits have a 20% coinsurance. Mental health specialty services, psychiatric services, and opioid treatment program services have a minimum and maximum coinsurance of 20%. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services with no copay. Annual physical exams, 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, counseling services are not covered. Other services such as Personal Emergency Response System (PERS), Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a coinsurance of at most 20%, while prescription hearing aids (all types) are covered up to a maximum of $4000 per year.
Vision Services See details
Vision services include coverage for eye exams and eyewear, with a 20% coinsurance for both. Routine eye exams are covered once per year, and there is a combined maximum of $375 per year for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services have a maximum plan benefit coverage of $3,500 every year. The plan also covers Oral Exams (2 visits per year), Dental X-Rays (1 per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (2 visits per year), Fluoride Treatment (1 visit per year), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay with 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Community First Medicare Advantage D-SNP (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Community First Medicare Advantage D-SNP (HMO D-SNP) plan. Durable Medical Equipment (DME) and Diabetic Supplies have a 20% coinsurance, while Prosthetic Devices, and Medicare-covered Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Community First Medicare Advantage D-SNP (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while all other diagnostic services have no copay and coinsurance.
Home Health Services See details
Home Health Services are covered by the Community First Medicare Advantage D-SNP (HMO D-SNP), with no copay and no coinsurance. However, 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 D-SNP (HMO D-SNP) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the coinsurance is based on the Medicare-defined cost share for tier 1.
Other Services See details
Other Services include an Over-the-Counter (OTC) Items benefit with a $475 maximum benefit every three months, as well as a Meal Benefit that requires 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved