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AbilityCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AbilityCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AbilityCare (HMO D-SNP) in 2026, please refer to our full plan details page.
AbilityCare (HMO D-SNP) is a HMO D-SNP plan offered by South Country Health Alliance available for enrollment in 2025 to people living in Select Counties in Minnesota. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that AbilityCare (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:
AbilityCare (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 AbilityCare (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 AbilityCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.60. 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 AbilityCare (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This means you will need to pay this deductible amount out-of-pocket for your covered medications before the plan begins to pay its share. Specific details regarding drug coverage tiers, copayments, and coinsurance are not currently available for this plan. To understand your exact prescription costs, it is recommended to verify your specific medications against the plan's formulary.
Additional Benefits
The AbilityCare (HMO D-SNP) plan offers comprehensive coverage for essential medical services with no copays for inpatient hospital stays, home health services, and skilled nursing facility care, all of which feature no coinsurance. For many outpatient services, primary and specialist care, emergency visits, and medical equipment, members will pay no copay but are responsible for a 20% coinsurance. Additionally, Medicare-covered preventive services and diagnostic hearing exams are fully covered with no copay and no coinsurance. Specialty benefits like vision and dental are partially covered, providing no copays and a 20% coinsurance for eyewear upgrades and Medicare-covered dental care, though routine exams are excluded. The plan also features valuable extra benefits, including a chronic illness meal benefit and a $90 quarterly over-the-counter item reimbursement with no copay and no coinsurance. Part B insulin is available with a $35 copay, while cardiac rehabilitation services are not covered by this plan.
Inpatient Hospital See details
AbilityCare (HMO D-SNP) partially covers inpatient hospital services, offering acute and psychiatric stays with no copay and no coinsurance. This benefit does not cover additional days, non-Medicare-covered stays, or upgrades.
Outpatient Services See details
Outpatient services are covered by AbilityCare (HMO D-SNP) with no copay, although a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for certain outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
AbilityCare (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
AbilityCare (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
AbilityCare (HMO D-SNP) covers emergency services and urgently needed services with a 20% coinsurance and no copay, which count toward the plan-level deductible and are waived if you are admitted to the hospital within 3 days. Emergency visits are capped at $115 and urgent care at $40, while some worldwide emergency services are covered but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
AbilityCare (HMO D-SNP) covers primary care, specialist visits, mental health, psychiatric, opioid treatment, and physical, occupational, and speech therapy services with no copay and 20% coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
AbilityCare (HMO D-SNP) partially covers preventive services, offering Medicare-covered zero-dollar preventive services and select additional benefits—including a personal emergency response system, memory fitness, and home safety devices—with no copay and no coinsurance. Other covered services, such as kidney disease education, glaucoma screenings, and diabetes self-management training, feature no copay and a 20% coinsurance. Several services, including annual physical exams, health education, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are partially covered by AbilityCare (HMO D-SNP), offering diagnostic hearing exams with no copay, no deductible, and no coinsurance, while routine exams and fitting evaluations are not covered. Some prescription hearing aid services are covered, but all types—including inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids—are not covered in practice.
Vision Services See details
Vision services are partially covered by AbilityCare (HMO D-SNP); routine eye exams, other eye exams, contact lenses, and eyeglasses are not covered, but eyewear upgrades are covered. Covered upgrades have no copay, a 20% coinsurance, and no deductible, up to a combined maximum plan benefit of $148.80 every year.
Dental Services See details
AbilityCare (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, alongside restorative services limited to one visit per year with no copay or coinsurance. However, routine preventive services like exams, cleanings, and x-rays, as well as endodontics, periodontics, prosthodontics, and oral surgery, are not covered.
Home Infusion bundled Services See details
AbilityCare (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B drugs—including chemotherapy, radiation, and other drugs—are covered with coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by AbilityCare (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, is covered by AbilityCare (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
AbilityCare (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Lab services are covered with no coinsurance, while diagnostic procedures, radiological services, therapeutic radiology, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the AbilityCare (HMO D-SNP) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by AbilityCare (HMO D-SNP), as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered in practice. Patients will face a 20% coinsurance and no copay for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by AbilityCare (HMO D-SNP) with no copay and no coinsurance for Medicare-covered days. Admission requires a prior three-day inpatient hospital stay, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
AbilityCare (HMO D-SNP) partially covers Other Services with no copay and no coinsurance, including a meal benefit for chronic illnesses and up to $90 every three months in over-the-counter item reimbursements. Acupuncture and other additional services are not covered.
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