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Clear Spring Health Silver Plan (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clear Spring Health Silver Plan (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 Silver Plan (HMO C-SNP) in 2025, please refer to our full plan details page.
Clear Spring Health Silver Plan (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. The overall rating for this plan is not yet available for 2025.
It's important to know that Clear Spring Health Silver Plan (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 Silver Plan (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 Silver Plan (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 Silver Plan (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 $5.50. 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 Silver Plan (HMO C-SNP) has a $250 deductible for prescription drugs. After the deductible is met, the plan covers drugs with varying copays or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and a $20 copay at standard pharmacies. For non-preferred drugs, you will pay 29% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Clear Spring Health Silver Plan (HMO C-SNP) offers comprehensive coverage, including inpatient hospital stays with a copay of $300 per day for the first five days, and no copay for days 6-90, along with coverage for outpatient services, partial hospitalization, ambulance, and emergency services. Primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility services are also covered. This plan includes additional benefits such as over-the-counter items with a monthly allowance, along with coverage for hearing aids, and vision services. The plan offers a range of copays and coinsurance amounts depending on the service, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $300 per day for days 1-5, and no copay for days 6-90. Additional days, non-Medicare-covered stays, and upgrades are not covered. Inpatient Hospital Psychiatric benefits are also covered, with the same cost structure as Inpatient Hospital.
Outpatient Services See details
Outpatient services are covered under the Clear Spring Health Silver Plan (HMO C-SNP), including outpatient hospital services with a $225 copay, observation services with a $225 copay, ambulatory surgical center (ASC) services with a $175 copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $50 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $225 copay, while transportation services to a plan-approved health-related location are covered for up to 12 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Clear Spring Health Silver Plan (HMO C-SNP), with a copay of $80 for emergency services and $45 for urgently needed services, and no coinsurance. Worldwide emergency services, urgent coverage, and transportation are not covered.
Primary Care See details
Primary Care for the Clear Spring Health Silver Plan (HMO C-SNP) includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $15 copay, and Occupational Therapy Services have a $35 copay. Physician Specialist Services have a copay between $0 and $25, and Physical Therapy and Speech-Language Pathology Services have a $40 copay. Individual and Group Sessions for Mental Health and Psychiatric Services and Opioid Treatment Program Services have a $30 copay, while Additional Telehealth Benefits have a $10 copay. Routine chiropractic care and Podiatry Services are not covered.
Preventive Services See details
The Clear Spring Health Silver Plan (HMO C-SNP) covers Medicare-covered preventive services with no copay. Additional preventive services are partially covered, as health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $30 copay. Fitting/evaluation for hearing aids is covered, and prescription hearing aids are covered up to $500 per year.
Vision Services See details
Vision services include routine eye exams with a $30 copay and eyeglasses (lenses and frames). Eyewear has a combined maximum benefit of $250 per year, while contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered under the Clear Spring Health Silver Plan (HMO C-SNP), including Medicare Dental Services with a $30 copay. Other services like Oral Exams, Dental X-Rays, and Orthodontic Services are also covered, with Oral Exams and Prophylaxis (Cleaning) covered every six months, and Dental X-Rays, Other Diagnostic Dental Services, Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics covered every year. Orthodontic Services have a maximum plan benefit coverage of $2000.00 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 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Clear Spring Health Silver Plan (HMO C-SNP), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered, with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, and no copay. Durable medical equipment for use outside the home and diabetic supplies and therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
The Clear Spring Health Silver Plan (HMO C-SNP) covers diagnostic and radiological services, including diagnostic procedures/tests and diagnostic radiological services with a coinsurance of at least 20%, and therapeutic radiological services with a coinsurance of at least 20%. Outpatient X-ray services have a $25 copay, and lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Clear Spring Health Silver Plan (HMO C-SNP) with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clear Spring Health Silver Plan (HMO C-SNP), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $167.00. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Clear Spring Health Silver Plan (HMO C-SNP) covers Over-the-Counter (OTC) items with a maximum benefit of $60.00 per month, including nicotine replacement therapy and Naloxone. Acupuncture, meal benefits, and other services are not covered.
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