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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 2025, 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 2025.
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 $50.60. 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 $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 $9350.00 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) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The AbilityCare (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including outpatient, partial hospitalization, ambulance, emergency, primary care, preventive, vision, dental, dialysis, medical equipment, and diagnostic services, come with a 20% coinsurance. Home health services have no copay or coinsurance. The plan also covers home infusion, with copays for Part B insulin drugs and coinsurance for other Part B drugs. Hearing exams have coinsurance, while hearing aids are not covered. The plan also covers Skilled Nursing Facility (SNF) services, but additional days beyond Medicare-covered stays are not.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with coinsurance costs as defined by Original Medicare; however, additional days, non-Medicare-covered stays, and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, both with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the AbilityCare (HMO D-SNP) plan with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by AbilityCare (HMO D-SNP), including both ground and air ambulance services, each with a 20% coinsurance and no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the AbilityCare (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, but no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The AbilityCare (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 and speech-language pathology services have a 20% coinsurance. Occupational therapy services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a coinsurance of 20%. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered. Medicare-covered zero-dollar preventive services are covered, but annual physical exams are not covered. Additional preventive services, including those not usually covered by Medicare, are covered with prior authorization. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit all have a 20% coinsurance.
Hearing Services See details
Hearing Services are covered, but routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered. Hearing exams have a coinsurance of at most 20% and no deductible.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams and eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are not covered.
Dental Services See details
The AbilityCare (HMO D-SNP) plan covers Medicare Dental Services with a 20% coinsurance, and also covers Prosthodontics, fixed with a limit of one visit every year. Orthodontic Services are covered, but Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AbilityCare (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the AbilityCare (HMO D-SNP) plan, with a 20% coinsurance for Durable Medical Equipment (DME), Prosthetic Devices, Medicare-covered Medical Supplies, Medicare-covered Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered, and there is no copay for these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the AbilityCare (HMO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no coinsurance. Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services all have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the AbilityCare (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover any of the sub-services. The plan does not specify any copay or coinsurance for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. The plan charges the Medicare-defined cost share for tier 1, but does not provide SNF services as a supplemental benefit under Part C and does not allow less than a 3-day inpatient hospital stay prior to SNF admission.
Other Services See details
Other Services are partially covered by the AbilityCare (HMO D-SNP) plan. Acupuncture, Over-the-Counter (OTC) Items, 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. The plan covers a meal benefit for a chronic illness, but there is no maximum plan benefit coverage amount.
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