Community First Medicare Advantage D-SNP (HMO D-SNP) By Community First Health Plans

Community First Medicare Advantage D-SNP (HMO D-SNP) H5447 002 0 is a 2023 Medicare Advantage Special Needs Plan plan by Community First Health Plans. This plan from Community First Health Plans works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Community First Health Plans and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Community First Medicare Advantage D-SNP (HMO D-SNP) H5447-002 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.

2023 Medicare Special Needs Plan Details

The Community First Medicare Advantage D-SNP (HMO D-SNP) H5447-002 is available to residents to Medicare eligible seniors in Texas. All Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Community First Medicare Advantage D-SNP (HMO D-SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

How much does Community First Medicare Advantage D-SNP (HMO D-SNP) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Community First Health Plans charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Community First Medicare Advantage D-SNP (HMO D-SNP) has a monthly drug premium of $25.00 and a $505.00 drug deductible. This Community First Health Plans plan offers a $25.00 Part-D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Community First Health Plans above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $25.00. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Community First Health Plans Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Community First Health Plans plan does not offer additional coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The Community First Medicare Advantage D-SNP (HMO D-SNP) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.20 for 75% low-income subsidy $12.50 for 50% and $18.70 for 25%.

H5447-002 Formulary and Drug Coverage

Community First Medicare Advantage D-SNP (HMO D-SNP) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Special Needs Plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2023 Summary of Benefits

The benefit information provided is a summary of what Community First Medicare Advantage D-SNP (HMO D-SNP) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Community First Health Plans helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Contact lenses

Eyeglass frames

Eyeglass lenses

Eyeglasses (frames and lenses)

Other

Routine eye exam

Upgrades

Occupational therapy visit

Physical therapy and speech and language therapy visit

Cleaning

Dental x-ray(s)

Fluoride treatment

Oral exam

Inpatient hospital - psychiatric

Outpatient group therapy visit

Outpatient group therapy visit with a psychiatrist

Outpatient individual therapy visit

Outpatient individual therapy visit with a psychiatrist

Chemotherapy

Other Part B drugs

Diabetes supplies

Durable medical equipment (e.g., wheelchairs, oxygen)

Prosthetics (e.g., braces, artificial limbs)

Fitting/evaluation

Hearing aids

Hearing exam

Foot exams and treatment

Routine foot care

Emergency

Urgent care

Primary

Specialist

Diagnostic radiology services (e.g., MRI)

Diagnostic tests and procedures

Lab services

Outpatient x-rays

Diagnostic services

Endodontics

Extractions

Non-routine services

Periodontics

Prosthodontics, other oral/maxillofacial surgery, other services

Restorative services

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Special Need Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Community First Medicare Advantage D-SNP (HMO D-SNP) requires you to live in that plan’s service area. The service area is listed below:

Source: CMS.

Plans as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change. All contracts for 2023 have not been finalized. For 2023, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2023 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.