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ElderServe Star (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ElderServe Star (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ElderServe Star (HMO I-SNP) in 2026, please refer to our full plan details page.
ElderServe Star (HMO I-SNP) is a HMO I-SNP plan offered by CareSource available for enrollment in 2025 to people living in Counties: Brx, Ki, Na, NY, Qu, Ri, Wes. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that ElderServe Star (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
ElderServe Star (HMO I-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 ElderServe Star (HMO I-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 ElderServe Star (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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 $615.00 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 $9250.00 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 ElderServe Star (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug coverage tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To find out how much your specific prescriptions will cost under this plan, it is recommended to review the plan's formulary or contact the provider directly.
Additional Benefits
The ElderServe Star (HMO I-SNP) plan generally offers coverage with no copay for most medical services, instead utilizing a standard 20% coinsurance. Key medical benefits such as outpatient care, emergency services, doctor visits, and diagnostic testing are covered under this cost-sharing structure, though prior authorization is often required. Additionally, home health services and skilled nursing facility stays for up to 100 days are covered with no copay and no coinsurance. For supplemental care, the plan features a monthly over-the-counter allowance of up to $185 with no copay or coinsurance. However, routine dental, vision, and hearing services, as well as routine transportation and cardiac rehabilitation, are not covered. Essential medical equipment, dialysis, and Medicare Part B insulin are covered, with insulin requiring a $35 copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by ElderServe Star (HMO I-SNP) with no copay and Medicare-defined coinsurance, requiring prior authorization for acute and psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
ElderServe Star (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, observation, and outpatient substance abuse services.
Partial Hospitalization See details
ElderServe Star (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by ElderServe Star (HMO I-SNP), which covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
ElderServe Star (HMO I-SNP) covers emergency services with a 20% coinsurance and no copay up to a $115 visit maximum, and urgently needed services with a 20% coinsurance and no copay up to a $40 visit maximum. Cost-sharing counts toward the plan-level deductible and is waived if admitted to the hospital within three days, though worldwide emergency, urgent, and emergency transportation services are not covered.
Primary Care See details
ElderServe Star (HMO I-SNP) covers primary care, specialist, psychiatric, and physical therapy services with no copay and a 20% coinsurance, with most services requiring prior authorization. While some chiropractic services are covered, routine and other chiropractic care are not covered, and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by ElderServe Star (HMO I-SNP), featuring no copay or coinsurance for Medicare-covered zero-dollar services, and no copay with a 20% coinsurance for kidney disease education and other screenings. Annual physical exams and additional services like fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
ElderServe Star (HMO I-SNP) hearing exams are partially covered with no copay, no coinsurance, and no deductible under prior authorization, while routine exams and fitting evaluations are not covered. Additionally, some prescription hearing aid services are covered, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered in practice.
Vision Services See details
Vision services under ElderServe Star (HMO I-SNP) are technically covered with no copay, 20% coinsurance, and no deductible. However, the benefit is not covered in practice as routine eye exams, other eye exam services, contact lenses, eyeglasses, and upgrades are all not covered.
Dental Services See details
Dental services are partially covered by ElderServe Star (HMO I-SNP), with covered Medicare dental services requiring prior authorization, no copay, and a 20% coinsurance. Other dental services, including oral exams, cleanings, x-rays, preventive care, restorative services, endodontics, periodontics, prosthodontics, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by ElderServe Star (HMO I-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
ElderServe Star (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by ElderServe Star (HMO I-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
ElderServe Star (HMO I-SNP) covers diagnostic and radiological services with no copay, subject to a 20% coinsurance and prior authorization. Covered services include diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
ElderServe Star (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the ElderServe Star (HMO I-SNP) plan, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
ElderServe Star (HMO I-SNP) covers Skilled Nursing Facility (SNF) care for days 1 through 100 with no copay and no coinsurance, though prior authorization and a 3-day inpatient hospital stay are required. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by ElderServe Star (HMO I-SNP), which offers a monthly reimbursement of up to $185 for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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