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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 Georgia Counties. This plan received an overall rating of 2.5 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 $300.00 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:
Sign up for Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)
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Drug Coverage
The Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) prescription drug plan features an annual drug deductible of $300. Beneficiaries enjoy no copay for Tier 6 select care drugs at any pharmacy, as well as no copay for Tier 1 preferred generics filled at preferred pharmacies or through preferred mail order. Tier 2 generic medications also feature no copay when using preferred mail order, though standard pharmacy copays start at $10. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs have a 35% coinsurance regardless of pharmacy type. Tier 5 specialty drugs require a 29% coinsurance and are limited to a one-month supply.
Additional Benefits
The Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, dialysis, and home health care. Specialist visits feature a low copay ranging from $0 to $35, while inpatient hospital stays require copays between $300 and $800 for the first five days with no copay thereafter. Emergency room services carry a $115 copay, which is waived if you are admitted, and outpatient hospital services require a $225 copay. Members also benefit from robust supplemental coverage, including preventive and comprehensive dental services with no copay up to a $2,000 annual limit. Routine vision and hearing exams require a $30 copay, which includes annual allowances of up to $250 for eyeglasses and $500 per ear for prescription hearing aids with no copay. Additionally, the plan covers up to 12 one-way transportation trips per year to plan-approved locations and provides a $50 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with no coinsurance, though prior authorization is required. Copays range from $300 to $800 for the first days of acute and psychiatric stays, with no copay for days 6 through 90, while upgrades, additional days, 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, featuring a $225 copay for outpatient hospital and observation services and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are covered 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 to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with a $275 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) plan are covered 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 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 and occupational therapy with no copay and no coinsurance, while specialist visits range from a $0 to $35 copay with no coinsurance. Other services like physical therapy have a $40 copay and psychiatric care has a $30 copay, both with no coinsurance, though routine chiropractic services are not covered.
Preventive Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are 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, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Hearing services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP), featuring a $30 copay and no coinsurance for annual routine exams and fittings with no deductible. Prescription hearing aids are covered with no copay or coinsurance up to a $500 maximum per ear annually, though over-the-counter options and inner, outer, or over-the-ear prescription models 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. One pair of eyeglasses (lenses and frames) is covered annually with no copay and no coinsurance up to a $250 maximum benefit, while contact lenses, individual lenses, individual frames, upgrades, and other eye exam services are not covered.
Dental Services See details
Dental services under Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) are partially covered, featuring no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental requires a $30 copay and no coinsurance. A $2,000 annual maximum applies to comprehensive services, though implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
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
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers durable medical equipment and prosthetics or medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though 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 Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP), as diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require prior authorization with no copay or coinsurance, whereas radiological services require prior authorization and carry a $25 copay for X-rays, a minimum $20 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
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, though only some services are covered in practice. Specific services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, 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, requiring prior authorization and a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $167 copay for days 21 through 100, and no coverage for additional days beyond the Medicare-covered limit.
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, while acupuncture and meal benefits are not covered.
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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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