Community Care's Partnership Program (HMO D-SNP)

Wisconsin Medicare-Medicaid Dual Eligible D-SNP Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Community Care

Additional Coverage

HearingDental

Overall Government Star Rating

No Rating (new plan)

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Plan Name
Community Care's Partnership Program (HMO D-SNP)
Insurance Carrier
Community Care
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Network Type
HMO

Community Care's Partnership Program (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in Wisconsin and offered by the health insurance company Community Care. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$8,850
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

Community Care's Partnership Program (HMO D-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 $8,850 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 Community Care's Partnership Program (HMO D-SNP) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
No
Vision
Yes
Hearing

Community Care's Partnership Program (HMO D-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. Community Care's Partnership Program (HMO D-SNP) includes coverage for hearing, dental.

Medicare Advantage health plans can offer even more additional benefits. Community Care's Partnership Program (HMO D-SNP) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Limited coverage
Meals for short duration
Not covered
Annual physical exams
Not covered
Telehealth
Not covered

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$8,850 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
No
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
$0 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$0 copay
Outpatient x-rays
$0 copay
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
$0 copay
Outpatient hospital coverage
$0 copay

Skilled nursing facility

Skilled nursing facility
$0 copay

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$0 copay

Therapy services

Occupational therapy visit
$0 copay
Physical therapy & speech & language therapy visit
$0 copay

Mental health services

Outpatient group therapy with a psychiatrist
$0 copay
Outpatient individual therapy with a psychiatrist
$0 copay
Outpatient group therapy visit
$0 copay
Outpatient individual therapy visit
$0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
$0 copay
Prosthetics (like braces, artificial limbs)
$0 copay
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic
Preferred Brand
Non-Preferred Drug
Specialty Tier

Part B Drugs

Chemotherapy drugs
$0 copay
Other Part B drugs
$0 copay

Hearing

Hearing exam
$0 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
$0 copay
Cleaning
$0 copay
Fluoride treatment
$0 copay
Dental x-rays
$0 copay

Comprehensive dental

Non-routine services
$0 copay
Diagnostic services
$0 copay
Restorative services
$0 copay
Endodontics
$0 copay
Periodontics
$0 copay
Extractions
$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay

Vision

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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