Plan 2 is for residents of Brazoria, Chambers, Fort Bend, Galveston, Harris, Jefferson, Liberty and Montgomery Counties

Community Health Choice (HMO D-SNP)

Community Health Choice (HMO D-SNP) is a Medicare Advantage plan for people who are eligible for both Medicare and Medicaid.

It combines your Medicare Part A and Part B benefits, your Medicare Part D prescription drug coverage, and your Medicaid benefits, and you will receive these extra benefits all for a $0 premium.*

Benefit	Original Medicare	Community Health Choice (HMO D-SNP)
Hospital Stays	Yes	$0 copay
Doctor and Outpatient Care	Yes	$0 copay
Prescription Drugs	---	$0 copay for QMB and QMB+ levels for Medicare-covered services
Dental Coverage	---	$0 copay for covered services, $3,500 annual allowance for covered dental services
Vision Coverage	---	$0 copay for routine eye exams; up to $350 annual allowance for lenses/frames and contacts
Hearing Coverage	---	$0 copay for routine hearing exams; up to $1,000 allowance for hearing aids every two years
Over-the-Counter Benefit	---	$220 quarterly allowance to purchase OTC drugs
Transportation Benefit	---	$0 copay; up to 4 one-way trips per month to or from plan approved health related locations
Meals Benefit	---	$0 copay; up to 2 meals a day for 7 days following your discharge from the hospital
Flex Card	---	$250 quarterly allowance that may be used for groceries, rent assistance, and/or utility bills
In-Home Support Services	---	Up to 48 hours annually of assistance with daily activities, including housekeeping, shopping, meal preparation, dressing and grooming, managing medications, etc.

*This information is not a complete description of benefits. For more information on plan benefits, please call us at 1.833.276.8306 (TTY users should call 711) or view the Evidence of Coverage [link].

Footnotes

Community Health Choice Texas, Inc. is a (HMO D-SNP) plan with a Medicare contract. Enrollment in our plans depends on contract renewal.

ATTENTION: If you speak Spanish, language assistance services, free of charge, are available to you. Call 1.833.276.8306 (TTY: 711)

Community Health Choice Texas, Inc.’s pharmacy network includes limited lower-cost, preferred pharmacies in our 20-county service area. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1.833.276.8306 (TTY: 711) or consult the online pharmacy directory at communityhealthchoice.org/medicare

H9826_MK_10331_100422_M. Last updated October 4, 2022.

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Community Health Choice (HMO D-SNP)