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Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health Balance+ Diabetes & Heart (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 Balance+ Diabetes & Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
Clear Spring Health Balance+ Diabetes & Heart (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. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Clear Spring Health Balance+ Diabetes & Heart (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 Balance+ Diabetes & Heart (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 Balance+ Diabetes & Heart (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 Balance+ Diabetes & Heart (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 a $200.00 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 Balance+ Diabetes & Heart (HMO C-SNP) plan features a $200 drug deductible. For maximum cost savings, Tier 6 select care drugs have no copay at any pharmacy, and Tier 1 preferred generics have no copay when using preferred pharmacies or preferred mail order. Tier 2 generics are also available with no copay through preferred mail order, or for a low $5 copay for a one-month supply at preferred pharmacies. Higher-tier medications transition to coinsurance, with Tier 3 preferred brands requiring a 20% coinsurance and Tier 4 non-preferred drugs requiring a 35% coinsurance. Tier 5 specialty drugs carry a 30% coinsurance for a one-month supply. Standard pharmacies and standard mail-order options are also available but generally carry higher copays, starting at $5 for Tier 1 and $10 for Tier 2.
Additional Benefits
The Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) offers comprehensive healthcare coverage featuring no copay and no coinsurance for primary care, telehealth, home health, dialysis, and cardiac rehabilitation services. For specialist visits, members can expect a copay ranging from $0 to $25, while emergency room visits carry a $115 copay that is waived if admitted. Inpatient hospital stays require a copay between $290 and $800 for the initial days, followed by no copay for days 6 through 90. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $2,000 annual limit. Additionally, members receive no-copay routine eyeglasses up to $250 annually, prescription hearing aids up to $500 per ear, and a $50 monthly allowance for over-the-counter items. Routine transportation is also covered with no copay for up to 12 one-way trips per year to plan-approved locations.
Inpatient Hospital See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a copay for the initial days of a stay (ranging from $290 to $800) and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $225 copay and ambulatory surgical center services for a $175 copay. Outpatient substance abuse services are covered with a $45 copay and no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers ground and air ambulance services with a $225 copay and no coinsurance. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with a $115 copay and no coinsurance, and urgently needed services are covered with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers primary care, occupational therapy, and telehealth services with no copay and no coinsurance. Specialist visits require a $0 to $25 copay, physical therapy has a $40 copay, and mental health, psychiatric, and podiatry services carry a $30 copay, all with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers preventive services, such as annual physical exams and diabetes self-management training, with no copay and no coinsurance. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing Services under Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) are partially covered, offering routine exams and evaluations for a $30 copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to $500 per ear annually, though OTC hearing aids and prescription inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP), offering one routine eye exam per year for a $30 copay and no coinsurance, and one pair of eyeglasses per year with no copay and no coinsurance up to a $250 annual limit. Other eye exam services, contact lenses, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP), as implant services and orthodontics are not covered. Medicare-covered dental services require a $30 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance, subject to a $2,000 annual maximum.
Home Infusion bundled Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers Home Infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment is covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with no copay and 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) provides partially covered diagnostic and radiological services with prior authorization required. Diagnostic lab services have a $5.00 copay and no coinsurance, while diagnostic procedures and tests are not covered. Radiological services require a $25.00 copay for X-rays, a minimum $20.00 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with no copay and no coinsurance, but only some services are covered as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers Skilled Nursing Facility (SNF) stays with no coinsurance, featuring no copay for days 1 to 20 and a $167 daily copay for days 21 to 100. Prior authorization and a prior three-day inpatient hospital stay are required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $50 monthly limit. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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