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Community DualCare Access (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Community DualCare Access (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 Access (HMO D-SNP) in 2026, please refer to our full plan details page.
Community DualCare Access (HMO D-SNP) is a HMO D-SNP plan offered by Harris County Hospital District available for enrollment in 2026 to people living in Jefferson Area. The overall rating for this plan is not yet available for 2026.
It's important to know that Community DualCare Access (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 Access (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 Access (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 Access (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 Access (HMO D-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This cost-saving benefit applies to one-month, two-month, and three-month supplies of these medications. For other drug categories, including Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for standard pharmacy or standard mail order fills. Tier 5 specialty drugs also require a 25% coinsurance, which is available for a one-month supply. These predictable coinsurance rates help you manage your healthcare budget for brand-name and specialty medications.
Additional Benefits
The Community DualCare Access (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For most outpatient visits, primary care, emergency services, and medical equipment, members will pay no copay but are responsible for a 20% coinsurance. Many preventive services are also fully covered with no copay or coinsurance. Additionally, this plan provides valuable supplemental benefits including dental care up to a $3,500 annual limit and prescription hearing aids up to a $1,500 limit with no copay or coinsurance. Members also benefit from no copay or coinsurance for up to 48 one-way transportation trips per year and a $100 monthly over-the-counter allowance. Up to 24 acupuncture treatments per year and meal benefits for chronic illnesses are also covered with no copay and no coinsurance.
Inpatient Hospital See details
Community DualCare Access (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under the Community DualCare Access (HMO D-SNP) plan with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, including hospital, observation, and ambulatory surgical center visits.
Partial Hospitalization See details
Community DualCare Access (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Community DualCare Access (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance (waived if admitted) and no copay. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Community DualCare Access (HMO D-SNP) covers emergency services with a 20% coinsurance (up to $115 per visit) and no copay, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay, with coinsurance waived if admitted to the hospital within one day. Worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Community DualCare Access (HMO D-SNP) provides partially covered primary care benefits with no copay and 20% coinsurance for covered services, including primary care, specialist visits, mental health, and physical therapy. Podiatry services and other non-routine chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by Community DualCare Access (HMO D-SNP), featuring no copay and no coinsurance for Medicare-covered zero-dollar services, in-home support, and remote access. Covered kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, and EKGs carry no copay but require a 20% coinsurance. Annual physical exams, fitness benefits, and health education are not covered.
Hearing Services See details
Community DualCare Access (HMO D-SNP) partially covers hearing services, offering routine hearing exams with no copay and 20% coinsurance, and prescription hearing aids with no copay or coinsurance up to a $1,500 annual maximum. Fitting and evaluations, over-the-counter hearing aids, and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Community DualCare Access (HMO D-SNP) with no deductibles, featuring one routine eye exam per year and contact lenses with no copay and a 20% coinsurance. Eyeglasses (lenses and frames) are covered with no copay or coinsurance up to a combined $250 annual limit, but other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Community DualCare Access (HMO D-SNP) plan, with Medicare-covered dental requiring no copay and a 20% coinsurance, while other covered dental services have no copay and no coinsurance up to a $3,500 annual limit. However, fluoride treatment, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Community DualCare Access (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay that applies to the plan deductible.
Dialysis Services See details
Community DualCare Access (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Community DualCare Access (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Community DualCare Access (HMO D-SNP) covers diagnostic and radiological services, including lab work, tests, therapeutic radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Community DualCare Access (HMO D-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 covered by Community DualCare Access (HMO D-SNP) with no copay and require prior authorization, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Community DualCare Access (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, but a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
Community DualCare Access (HMO D-SNP) provides partial coverage for other services with no copay and no coinsurance, which includes up to 24 acupuncture treatments per year, a $100 monthly over-the-counter allowance, and meal benefits for chronic illnesses. Highly integrated dual eligible services, nicotine replacement therapy, and certain other unspecified services are not covered.
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