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Clear Spring Health Essential (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health Essential (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clear Spring Health Essential (HMO C-SNP) in 2025, please refer to our full plan details page.
Clear Spring Health Essential (HMO C-SNP) is a HMO C-SNP plan offered by Group 1001 available for enrollment in 2025 to people living in Select Colorado Counties. The overall rating for this plan is not yet available for 2025.
It's important to know that Clear Spring Health Essential (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:
Clear Spring Health Essential (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 Clear Spring Health Essential (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 Clear Spring Health Essential (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 $4.50. 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 a $250.00 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 $6751.00 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 Clear Spring Health Essential (HMO C-SNP) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay when using a preferred pharmacy or preferred mail order, and a $20 copay at a standard pharmacy or standard mail order. For non-preferred drugs, you will pay 29% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Clear Spring Health Essential (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay for days 6-90, while outpatient services and emergency services have set copays. This plan also includes coverage for primary care, hearing, vision, and dental services with copays for specific services. Additionally, it provides coverage for ambulance and transportation services, home infusion, dialysis, medical equipment, and diagnostic and radiological services with coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital benefits with Clear Spring Health Essential (HMO C-SNP) require prior authorization and have a copay of $290 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days, non-Medicare covered stays, and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $225 copay, observation services with a $225 copay, and ambulatory surgical center services with a $175 copay. Outpatient substance abuse services are covered with a $45 copay for both individual and group sessions, but outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Clear Spring Health Essential (HMO C-SNP) plan, with a $50 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Clear Spring Health Essential (HMO C-SNP) plan. Ground and air ambulance services have a $225 copay, and there is no coinsurance. Transportation services to a plan-approved health-related location are covered for 12 one-way trips per year, with no copay or coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Clear Spring Health Essential (HMO C-SNP) plan with a $80 copay, and Urgently Needed Services are covered with a $45 copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Clear Spring Health Essential (HMO C-SNP) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $35 copay, physician specialist services with a $0-$25 copay, mental health specialty services with a $30 copay, other health care professional services with a $30 copay, psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $10 copay, and opioid treatment program services with a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by the Clear Spring Health Essential (HMO C-SNP) plan, though annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered. Re-admission prevention, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, as well as routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids are covered up to $500 per year, and prescription hearing aids (all types) are covered twice per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay and routine eye exams once per year, along with eyeglasses (lenses and frames) with a combined maximum benefit of $250 every year. Contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services with a $30 copay. Other dental services include oral exams (1 visit every six months), dental x-rays (2 per year), other diagnostic dental services (2 per year), prophylaxis (cleaning) (1 visit every six months), fluoride treatment (1 per year), other preventative dental services (2 per year), orthodontics, restorative services (2 per year), adjunctive general services (2 per year), endodontics (2 per year), periodontics (2 per year), prosthodontics, removable (2 per year), maxillofacial prosthetics (2 per year), implant services (2 per year), prosthodontics, fixed (2 per year), oral and maxillofacial surgery (2 per year), and orthodontics (2 per year). Orthodontic services have a maximum benefit of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and coinsurance between 0% and 20% for Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Clear Spring Health Essential (HMO C-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a coinsurance of up to 20%, and lab services with a $5 copay. Radiological services are also covered, including diagnostic and therapeutic radiological services with a coinsurance of up to 20%, and outpatient X-ray services with a $25 copay.
Home Health Services See details
Home Health Services are covered by the Clear Spring Health Essential (HMO C-SNP) plan with no copay and no coinsurance, but require authorization. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clear Spring Health Essential (HMO C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $167.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items with a maximum benefit of $60.00 per month, and the plan offers nicotine replacement therapy and Naloxone coverage as an OTC benefit. Acupuncture, meal benefits, 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.
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