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Community y Más (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community y Más (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community y Más (HMO C-SNP) in 2026, please refer to our full plan details page.
Community y Más (HMO C-SNP) is a HMO C-SNP plan offered by Community Health Group available for enrollment in 2025 to people living in San Diego County California. The overall rating for this plan is not yet available for 2026.
It's important to know that Community y Más (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:
Community y Más (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 Community y Más (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 Community y Más (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1000.00 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 Community y Más (HMO C-SNP) Medicare plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, which lasts until total drug costs reach $2,100, standard pharmacy pricing includes a $9 copay for preferred generics and a $47 copay for standard generics. Preferred brand drugs require a 50% coinsurance, non-preferred drugs carry a 33% coinsurance, and specialty tier drugs feature no copay. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy can reduce their Part D costs to $0.
Additional Benefits
The Community y Más (HMO C-SNP) plan offers affordable healthcare coverage featuring no deductible for several key services and clear cost-sharing terms. For inpatient hospital stays, members pay a $75 daily copay for days 1 through 3 and no copay for days 4 through 90, with no coinsurance required. Outpatient hospital services require a $75 copay, while emergency room visits carry a $140 copay, both with no coinsurance. This plan also includes valuable supplemental benefits like comprehensive dental coverage up to a $2,300 annual limit and a $200 quarterly over-the-counter allowance. Vision and hearing services feature no deductible, providing a $300 annual eyewear allowance and a $750 hearing aid allowance every three years. Additionally, members can access up to 24 one-way rideshare trips per year and routine acupuncture treatments with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Community y Más (HMO C-SNP) with no coinsurance and a $75 daily copay for days 1 through 3, followed by no copay for days 4 through 90. While acute and psychiatric stays are covered, upgrades for acute care and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are partially covered under Community y Más (HMO C-SNP), with outpatient hospital and daily observation services requiring a $75 copay and no coinsurance. While ambulatory surgical and blood services are also covered, individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Community y Más (HMO C-SNP) plan, requiring a doctor referral to receive these services.
Ambulance and Transportation Services See details
Community y Más (HMO C-SNP) covers ground and air ambulance services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered, offering up to 24 one-way rideshare trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Community y Más (HMO C-SNP) covers emergency services with a $140 copay and no coinsurance (waived if admitted to the hospital within 24 hours), and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum benefit, with a $140 copay and no coinsurance for worldwide emergency and urgent coverage, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are covered by Community y Más (HMO C-SNP), including physical therapy, telehealth, and routine chiropractic care, though podiatry is not covered. For mental health and psychiatric specialty services, some services are covered but individual and group sessions are not, with specific copay and coinsurance details not provided.
Preventive Services See details
Community y Más (HMO C-SNP) partially covers preventive services, offering Medicare-covered zero-dollar preventive services with no copay and no coinsurance. However, several sub-services are not covered, including annual physical exams, fitness benefits, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, telemonitoring, counseling, and home-based support services.
Hearing Services See details
Hearing services are partially covered by Community y Más (HMO C-SNP) with no deductible, offering one routine hearing exam and one fitting evaluation annually, alongside a $750 allowance every three years for prescription hearing aids. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by Community y Más (HMO C-SNP) with no deductible, offering one routine eye exam every year and a $300 annual maximum for contact lenses and eyeglasses. This benefit is partially covered, as standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered, while specific copay and coinsurance details are not specified.
Dental Services See details
Community y Más (HMO C-SNP) covers comprehensive and preventive dental services, including unlimited exams, cleanings, and x-rays, up to a maximum annual benefit of $2,300. Advanced treatments like endodontics, periodontics, and restorative services are also covered, though they require prior authorization and a doctor referral.
Home Infusion bundled Services See details
Community y Más (HMO C-SNP) covers home infusion bundled services, which require prior authorization. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and carry a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Community y Más (HMO C-SNP) plan, though specific copay and coinsurance costs are not detailed in this benefit summary.
Medical Equipment See details
Medical equipment is partially covered by Community y Más (HMO C-SNP), with covered durable medical equipment and prosthetics requiring a 15% coinsurance and no copay, subject to prior authorization. For diabetic equipment, some services are covered, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Community y Más (HMO C-SNP), where only diagnostic radiological services are covered with a copay ranging from no copay up to $75 and no coinsurance. Other sub-services, including diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, are not covered.
Home Health Services See details
Home Health Services are covered by Community y Más (HMO C-SNP), requiring prior authorization and a doctor referral. Specific copay and coinsurance cost information is not provided for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community y Más (HMO C-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Community y Más (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services, though additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and a doctor referral, costing no copay and no coinsurance for days 1 to 20, and a $200 daily copay with no coinsurance for days 21 to 100.
Other Services See details
Community y Más (HMO C-SNP) covers other services with no copay or coinsurance, including up to 12 acupuncture treatments per year, a home meal benefit for chronic conditions, and a $200 quarterly over-the-counter allowance. Highly integrated services for dual-eligible SNPs are not covered under this plan.
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