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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. If you qualify for the low-income subsidy, your monthly premium for Part D is $18.30. Once you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. After 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 range of benefits with varying cost-sharing. Many services, including outpatient services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, and skilled nursing facilities, have a 20% coinsurance. Some services, such as ambulance and transportation, emergency services, and home health services, have no copay. Additionally, the plan provides coverage for specific services like acupuncture, with a limit of 24 treatments per year, over-the-counter (OTC) items up to $100 per month, and meal benefits for chronic illnesses. However, it is important to note that certain services, such as cardiac rehabilitation, are not covered. Inpatient hospital and skilled nursing facility services have the Medicare-defined cost share for tier 1.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with prior authorization required. The plan does not specify the cost-sharing, but does state that it charges the Medicare-defined cost share for tier 1.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services, both with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a coinsurance of at least 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 a 20% coinsurance for ground and air ambulance services, and no copay. Transportation Services to any health-related location are covered, with a limit of 48 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Community Health Choice (HMO D-SNP). Emergency and Urgently Needed Services have a 20% coinsurance, but there is no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The Community Health Choice (HMO D-SNP) plan covers 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 with a 20% coinsurance. Routine chiropractic care is covered for up to 24 visits per year, and individual and group sessions for both mental health and psychiatric services have a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, but annual physical exams are not covered. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit are covered with 20% coinsurance. Other services like Health Education, In-Home Safety Assessments, and more are not covered.
Hearing Services See details
Hearing services include coverage for routine hearing exams with a coinsurance of at most 20% per year for one visit, and prescription hearing aids with a plan-specified amount of $1000 per year for two visits; however, fitting/evaluation for hearing aids, prescription hearing aids for inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and for eyewear with a 20% coinsurance, including a combined maximum plan benefit of $350 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Community Health Choice (HMO D-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Other dental services are covered up to a maximum of $4,500 per year. The plan covers oral exams (limited to 1 visit every six months), dental x-rays (limited to 1 per year), other diagnostic dental services, prophylaxis (cleaning) (limited to 1 visit every six months), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. 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 under the Community Health Choice (HMO D-SNP) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Community Health Choice (HMO D-SNP) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a 20% coinsurance, and authorization is required. Prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes/inserts each have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Community Health Choice (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, and Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%, with no copay for any of these services.
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) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. You will pay the Medicare-defined cost share for tier 1, and prior authorization is required.
Other Services See details
The Community Health Choice (HMO D-SNP) plan covers acupuncture, with a limit of 24 treatments per year. Over-the-counter (OTC) items are covered up to $100.00 per month, and meal benefits are covered for chronic illnesses with prior authorization and a doctor's referral. However, several other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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