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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 2025, 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 Community Health Group. The overall rating for this plan is not yet available for 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $25.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $600.00 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay depending on the drug tier and the pharmacy you use. For example, you will pay a $9 copay for preferred generic drugs at a standard pharmacy. In the catastrophic coverage phase, you pay nothing for covered Part D drugs after your yearly out-of-pocket drug costs reach $2000. This plan may reduce your premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Community y Más (HMO C-SNP) plan offers a variety of benefits with varying costs. Inpatient and outpatient services, including some mental health services, are covered. Emergency services have a $100 copay, while ambulance services have a $100 copay. Preventive, hearing, vision, and dental services are included, with specific coverage limits and copays. Home health and dialysis services are covered with no copay. The plan also includes medical equipment, home infusion, and other services like acupuncture and OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the Community y Más (HMO C-SNP) plan. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered under the Community y Más (HMO C-SNP) plan with a $40 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are also covered, while Individual and Group Sessions for Outpatient Substance Abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for ambulance services. Ground and air ambulance services have a $100 copay, and transportation services to a plan-approved health-related location are covered for up to 24 one-way rides per year via rideshare services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a $100 copay, with no coinsurance, while Worldwide Emergency Transportation is not covered. Worldwide Urgent Coverage also has a $100 copay, with no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services includes coverage for routine chiropractic care with a limit of 12 visits per year, and also requires prior authorization and a doctor referral. Mental Health Specialty Services and Psychiatric Services are partially covered, but individual and group sessions are not. Podiatry Services are not covered.
Preventive Services See details
The Community y Más (HMO C-SNP) plan covers Medicare-covered preventive services, and additional preventive services, including health education, in-home safety assessments, post-discharge in-home medication reconciliation, re-admission prevention, nutritional/dietary benefits, enhanced disease management, remote access technologies, home and bathroom safety devices, and kidney disease education services. The plan does not cover annual physical exams, personal emergency response systems, medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, fitness benefits, telemonitoring services, or counseling services.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, both of which are covered with no copay, once per year. Prescription hearing aids are covered up to $750 every three years, and all types of prescription hearing aids are covered. However, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Community y Más (HMO C-SNP) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $400 per year. Contact lenses, eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The Community y Más (HMO C-SNP) plan offers dental services with a maximum plan benefit of $3,500 per year. Services such as oral exams, dental x-rays, and other diagnostic dental services are covered, as are prophylaxis (cleaning), fluoride treatments, and other preventive dental services. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics, all of which require prior authorization and a doctor referral.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Community y Más (HMO C-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 10% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 10% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Community y Más (HMO C-SNP), but the plan does not cover Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, or Outpatient X-Ray Services, and there is no copay for covered services. Prior authorization is required for Radiological Services.
Home Health Services See details
Home Health Services are covered by the Community y Más (HMO C-SNP) plan with no copay and no coinsurance, but authorization and a referral are required. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Community y Más (HMO C-SNP) plan, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for these services if they were covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required for SNF services.
Other Services See details
The Community y Más (HMO C-SNP) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture requires prior authorization and a doctor referral, and is limited to 12 treatments per year. OTC items are provided as a supplemental benefit with a maximum coverage amount of $200 every three months and includes nicotine replacement therapy and Naloxone coverage. The meal benefit also requires prior authorization and a doctor referral.
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