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Community DualCare Aligned (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community DualCare Aligned (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 DualCare Aligned (HMO D-SNP) in 2026, please refer to our full plan details page.
Community DualCare Aligned (HMO D-SNP) is a HMO D-SNP plan offered by Harris County Hospital District available for enrollment in 2026 to people living in Harris Area. The overall rating for this plan is not yet available for 2026.
It's important to know that Community DualCare Aligned (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 DualCare Aligned (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 DualCare Aligned (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 DualCare Aligned (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 Community DualCare Aligned (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, members pay no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. This ensures affordable access to many common and essential medications. For other medication categories, members are responsible for a 25% coinsurance through standard pharmacies and standard mail order. This 25% coinsurance applies to Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs for up to a three-month supply, as well as Tier 5 specialty drugs for a one-month supply.
Additional Benefits
The Community DualCare Aligned (HMO D-SNP) plan offers comprehensive medical coverage with no copay for most essential services. Inpatient hospital stays, home health care, and skilled nursing facility services are covered with no copay and no coinsurance. For outpatient services, primary care, emergency care, and diagnostic tests, members will pay no copay and a 20% coinsurance. Additionally, the plan provides robust supplemental benefits including dental coverage up to a $4,500 annual limit and prescription hearing aids up to a $3,000 yearly limit with no copay or coinsurance. Members also receive up to 48 one-way trips to plan-approved locations per year and a $105 monthly allowance for over-the-counter items with no copay. Vision care is covered with no copay, featuring a $350 annual allowance for eyewear.
Inpatient Hospital See details
Inpatient hospital services are covered by Community DualCare Aligned (HMO D-SNP) with no copay and no coinsurance for acute and psychiatric stays, though prior authorization is required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Community DualCare Aligned (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Community DualCare Aligned (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Community DualCare Aligned (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance (waived if admitted) and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Community DualCare Aligned (HMO D-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within one day. 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
Community DualCare Aligned (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and telehealth services with no copay and 20% coinsurance. Chiropractic services are partially covered with no copay and 20% coinsurance for up to 24 routine visits per year, while other chiropractic services and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Community DualCare Aligned (HMO D-SNP), offering select additional services with no copay and no coinsurance, alongside kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs for no copay and 20% coinsurance. Uncovered sub-services include annual physical exams, fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Community DualCare Aligned (HMO D-SNP), offering routine hearing exams with no copay, 20% coinsurance, and no deductible, as well as prescription hearing aids with no copay or coinsurance up to a $3,000 yearly limit. However, fitting or evaluation exams, OTC hearing aids, and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Community DualCare Aligned (HMO D-SNP), featuring no copay for covered services, a 20% coinsurance for routine eye exams and contact lenses, and no coinsurance for eyeglasses. Up to $350 is covered annually for eyewear, but other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Community DualCare Aligned (HMO D-SNP), featuring Medicare dental coverage with no copay and a 20% coinsurance, and other dental benefits with no copay and no coinsurance up to a $4,500 annual limit. While exams, cleanings, and restorative care are covered, fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Community DualCare Aligned (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B drugs—including chemotherapy, radiation, and insulin—require 0% to 20% coinsurance, with insulin also carrying a $35 copay that applies to the plan deductible.
Dialysis Services See details
Dialysis Services are covered by Community DualCare Aligned (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Community DualCare Aligned (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Community DualCare Aligned (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered by Community DualCare Aligned (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Community DualCare Aligned (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. While some services are covered, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community DualCare Aligned (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. A prior three-day inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Community DualCare Aligned (HMO D-SNP) covers other services with no copay and no coinsurance, including up to 24 acupuncture treatments yearly and a $105 monthly over-the-counter item allowance. Chronic illness meal benefits are also covered with no copay or coinsurance, though prior authorization and a referral are required.
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