Sentara Medicare Engage- Lung (HMO C-SNP)
Virginia Chronic Condition Special Needs C-SNP Plan (2025 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
3.0
out of 5 stars
Plan Name
Sentara Medicare Engage- Lung (HMO C-SNP)
Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Sentara Medicare Engage- Lung (HMO C-SNP) is a Chronic Condition Special Needs Plan (C-SNP), which is available in Virginia and offered by the health insurance company Sentara Medicare. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$10 copay per visit
ER visit
$140 copay per visit (always covered)
Sentara Medicare Engage- Lung (HMO C-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,500 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Sentara Medicare Engage- Lung (HMO C-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Sentara Medicare Engage- Lung (HMO C-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Sentara Medicare Engage- Lung (HMO C-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Sentara Medicare Engage- Lung (HMO C-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Sentara Medicare Engage- Lung (HMO C-SNP) received an overall government quality rating of 3.0 stars out of 5 stars.
Sentara Medicare Engage- Lung (HMO C-SNP) performed worse than Virginia’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
Virginia State Average Score
Overall Government 5 Star Quality Rating
3.0
3.8
Summary rating of health plan quality
Staying healthy: screenings, tests, & vaccines
Managing chronic (long term) conditions
Member experience with health plan
Member complaints & changes in the health plan's performance
Health plan customer service
Summary rating of drug plan quality
Drug plan customer service
Member complaints & changes in the drug plan's performance
Member experience with the drug plan
Drug safety & accuracy of drug pricing
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Sentara Medicare Engage- Lung (HMO C-SNP) received 3 stars for its health plan quality score which is worse than the Virginia State average health plan quality score of 3.7 stars.
Sentara Medicare Engage- Lung (HMO C-SNP) received 3.5 stars for its drug plan quality score which is worse than the Virginia State average drug plan quality score of 3.8 stars.
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Emergency care
$140 copay per visit (always covered)
Urgent care
$15 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
$275 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
Skilled nursing facility
Skilled nursing facility
$0 per day for days 1 through 20
$214 per day for days 21 through 100
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
Prosthetics (like braces, artificial limbs)
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|
Preferred Generic | $5.00 copay | $0 copay |
Generic | $20.00 copay | $0 copay |
Preferred Brand | $47.00 copay | $0 copay |
Non-Preferred Drug | $100.00 copay | $0 copay |
Specialty Tier | 31% coinsurance | $0 copay |
Part B Drugs
Hearing
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Restorative services
In-network: $35 copay
Out-of-network: $35 copay
Endodontics
In-network: $35 copay
Out-of-network: $35 copay
Periodontics
In-network: $35 copay
Out-of-network: $35 copay
Prosthodontics, removable
In-network: $35 copay
Out-of-network: $35 copay
Maxillofacial prosthetics
Oral and maxillofacial surgery
In-network: $35 copay
Out-of-network: $35 copay
Adjunctive general services
In-network: $35 copay
Out-of-network: $35 copay
Vision
Eyeglasses (frames & lenses)
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