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Clear Spring Health Essential (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health Essential (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clear Spring Health Essential (HMO C-SNP) in 2025, please refer to our full plan details page.
Clear Spring Health Essential (HMO C-SNP) is a HMO C-SNP plan offered by Group 1001 available for enrollment in 2025 to people living in Metro Chicago. The overall rating for this plan is not yet available for 2025.
It's important to know that Clear Spring Health Essential (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Clear Spring Health Essential (HMO C-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 Clear Spring Health Essential (HMO C-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 Clear Spring Health Essential (HMO C-SNP), 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $250.00 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 $6751.00 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 Clear Spring Health Essential (HMO C-SNP) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay no copay at preferred pharmacies and preferred mail order, and a $20 copay at standard pharmacies and standard mail order. For non-preferred drugs, you pay 29% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Clear Spring Health Essential (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with copays, and outpatient services such as outpatient hospital, substance abuse, and mental health services with varying copays. The plan also provides coverage for ambulance services, emergency services, and primary care services like chiropractic, vision, and dental services. Additional benefits include hearing aids, vision services, dental services, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $290 copay for days 1-5, and no copay for days 6-90; you will pay an $800 copay for days 1-60. For Inpatient Hospital Psychiatric, you will pay a $290 copay for days 1-5, and no copay for days 6-90; you will pay an $800 copay for days 1-60. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $225 copay, observation services with a $225 copay, ambulatory surgical center (ASC) services with a $175 copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Clear Spring Health Essential (HMO C-SNP) plan, with a $50 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $225 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for 12 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Clear Spring Health Essential (HMO C-SNP) plan. Emergency Services have an $80 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Clear Spring Health Essential (HMO C-SNP) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $0-$25 copay, mental health specialty services with a $30 copay, other health care professional services with a $30 copay, psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $10 copay, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay. Additional preventive services are partially covered, but do not include annual physical exams, health education, in-home safety assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, 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, home and bathroom safety devices and modifications, or counseling services. Kidney Disease Education Services and other preventive services are also covered.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $500 per year. Prescription hearing aids are covered for all types, but not inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a $30 copay, and coverage for eyeglasses (lenses and frames) with a combined maximum benefit of $250 every year. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Clear Spring Health Essential (HMO C-SNP) plan covers dental services with a $30 copay for Medicare dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics. Orthodontic services have a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
The Clear Spring Health Essential (HMO C-SNP) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Clear Spring Health Essential (HMO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment. 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 under the Clear Spring Health Essential (HMO C-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have a $5 copay. Outpatient X-Ray Services have a $25 copay, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
The Clear Spring Health Essential (HMO C-SNP) plan covers Skilled Nursing Facility (SNF) stays with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $167.
Other Services See details
The "Other Services" benefit in the Clear Spring Health Essential (HMO C-SNP) plan covers over-the-counter items with a maximum benefit coverage amount of $60.00 every month, including nicotine replacement therapy and Naloxone. Acupuncture, meal benefits, 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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