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Community Health Choice (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community Health Choice (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Community Health Choice (HMO D-SNP) in 2025, please refer to our full plan details page.
Community Health Choice (HMO D-SNP) is a HMO D-SNP plan offered by Harris County Hospital District available for enrollment in 2025 to people living in Southeast Texas. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Community Health Choice (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Community Health Choice (HMO D-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 Community Health Choice (HMO D-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 Community Health Choice (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 $590.00 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 $9150.00 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 Community Health Choice (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Community Health Choice (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services, including Home Health and Emergency Services, have no copay. Other services, like primary care, outpatient services, vision, hearing, and dental, have a 20% coinsurance. The plan also covers services like home infusion, dialysis, and durable medical equipment, all with coinsurance. There are also additional benefits such as acupuncture, an over-the-counter allowance, and a meal benefit, which can help with costs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Additional Days, Non-Medicare-covered Stay, and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. The coinsurance for these services is defined by Medicare.
Outpatient Services See details
Outpatient Services include outpatient hospital services and observation services, each with a 20% coinsurance, along with Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, both of which have a coinsurance of 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay. Both ground and air ambulance services have a 20% coinsurance, but the coinsurance is waived if admitted to the hospital. Transportation services to a plan-approved health-related location are covered for up to 48 one-way trips per year.
Emergency Services See details
Emergency Services are covered by Community Health Choice (HMO D-SNP), with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
For the Community Health Choice (HMO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered with a 20% coinsurance. Routine chiropractic care is covered for 24 visits per year with a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered by the Community Health Choice (HMO D-SNP) plan. Medicare-covered preventive services are covered with no copay. Additional preventive services are partially covered, with services like Health Education and Therapeutic Massage not covered, and other services like Glaucoma Screening and Diabetes Self-Management Training having a 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20% and up to one visit per year, and prescription hearing aids with a maximum benefit of $1,000 per year for both ears combined. Fitting/evaluation for hearing aids, prescription hearing aids for the inner, outer, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear also has a 20% coinsurance, and contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Community Health Choice (HMO D-SNP) covers dental services, including Medicare Dental Services with 20% coinsurance and other dental services with a $4,500 annual maximum. Oral exams are covered for one visit every six months, while dental x-rays are covered for one per year. Other diagnostic dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are also covered. However, fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Community Health Choice (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Community Health Choice (HMO D-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies are covered with a 20% coinsurance, and diabetic equipment is covered, including diabetic supplies and therapeutic shoes/inserts, each with a 20% coinsurance. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Community Health Choice (HMO D-SNP). Diagnostic procedures, tests, and lab services have no copay, with a coinsurance of at most 20%, while diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have no copay, with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by Community Health Choice (HMO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Community Health Choice (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for SNF are not covered. You will be responsible for the Medicare-defined cost share for tier 1, and there is coinsurance.
Other Services See details
Other Services for Community Health Choice (HMO D-SNP) includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a limit of 24 treatments per year, and OTC items have a maximum benefit of $105.00 per month, while the meal benefit requires a doctor's referral.
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