2020 Community Health Choice (HMO D-SNP) DS-H9826

Community Health Choice (HMO D-SNP) By Community Health Choice

Community Health Choice (HMO D-SNP) is a 2020 Medicare Advantage Special Needs Plan plan by Community Health Choice. This plan from Community Health Choice 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 Health Choice and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Community Health Choice (HMO D-SNP) DS-H9826 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.

2020 Medicare Special Needs Plan Details

Plan Name:
Community Health Choice (HMO D-SNP)
Plan ID:
Special Needs Type: Dual-Eligible
Provider: Community Health Choice
Plan Year:2020
Plan Type: Local HMO
Monthly Premium C+D: $20.80


The Community Health Choice (HMO D-SNP) DS-H9826 is available to residents in Texas, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Community Health Choice (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.

Part-C Premium

Community Health Choice plan charges a $0.00 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

The Community Health Choice (HMO D-SNP) plan has a monthly drug premium of $20.80 and a $435.00 drug deductible. This Community Health Choice plan offers a $20.80 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 $0.00 this Premium covers any enhanced plan benefits offered by Community Health Choice 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 $20.80. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Community Health Choice (HMO D-SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.20 for 75% low income subsidy $10.40 for 50% and $15.60 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $20.80
Part D Supplemental Premium $0.00
Total Part D Premium: $20.80
Drug Deductible: $435.00
Tiers with No Deductible: 0
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Defined Standard Benefit
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $5.20
50% LIS Premium: $10.40
25% LIS Premium: $15.60
Gap Coverage: No

Gap Coverage

In 2020 once you and your plan provider have spent $4020 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 brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Community Health Choice plan does not offer additional coverage through the gap.

Community Health Choice Drug Coverage and Formulary

A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 Community Health Choice (HMO D-SNP) H9826-001 Formulary here.

Drug Tier Copay
1 NA $0
*Initial Coverage Phase and 30 day supply

See the 2020 Community Health Choice Formulary

Coverage Area for Community Health Choice (HMO D-SNP)

Source: CMS.

Plans as of September 4, 2019.

Star Rating as of October 11, 2019.

Plan Services are 2019 information as reference. 2020 information will be added when released.

Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, 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 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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