Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)

Clear Spring Health Balance+ Diabetes & Heart (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 2026.

It's important to know that Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) 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 Clear Spring Health Balance+ Diabetes & Heart (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.

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:

Drug Coverage

The Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) prescription drug plan features an annual drug deductible of $300. You will pay no copay for Tier 6 select care drugs at any pharmacy, and no copay for Tier 1 preferred generics at preferred pharmacies or through preferred mail order. Tier 2 generic medications also have no copay when filled through preferred mail order, while standard pharmacy copays for Tier 1 and Tier 2 drugs range from $5 to $30 depending on the supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 35% coinsurance across all pharmacy types. Specialty tier drugs under Tier 5 require a 29% coinsurance for a one-month supply.

Additional Benefits

The Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, and preventive services. For specialized care, specialist visits range from no copay to a $25 copay, while emergency room visits require a $115 copay that is waived if you are admitted. Outpatient hospital services carry a $225 copay, and inpatient hospital stays require copayments of either $290 per day for days 1 through 5 or $800 for days 1 through 60, with no coinsurance required for these services. This plan also features robust supplemental benefits, including preventive and comprehensive dental care with no copay up to a $2,000 annual limit. Members benefit from no copay for dialysis, home health services, and up to 12 one-way transportation trips per year, alongside a $50 monthly allowance for over-the-counter items. Vision and hearing services are also covered, featuring routine exams with a $30 copay and allowances of up to $250 yearly for eyewear and $500 per ear annually for prescription hearing aids.