A Dual Eligible Special Needs Plan, or D-SNP, is a Medicare plan for people who are eligible for both Medicare and full Medicaid coverage. If you are 65 or older with a qualifying income, or 21 or older with a qualifying disability, you may be eligible for a D-SNP plan.
A D-SNP combines your doctor, hospital, and prescription drug coverage into one plan. It also offers extra benefits you don’t get from Medicaid and Original Medicare, like dental coverage and transportation to or from a doctor’s office or pharmacy, at no additional cost.
You can call us at 833.276.8306 (toll-free) or 713.295.5007 (local) to speak with a licensed sales agent. TTY users should call 711. You can also click here to download an application.
Call us toll-free at 833.276.8306 or 713.295.5007 if you live in our service area. TTY users should call 711
You can also fill out the contact form and a licensed sales agent will call you.
You can search for doctors in the Community Health Choice (HMO D-SNP) plan or call Member Services to assist you.
Community Health Choice (HMO D-SNP) offers a 24-hour Nurse Advice Line for Members. Licensed nurses are available to answer any clinical or medical questions. If this is a medical emergency, please call 911.
If you are having trouble getting your prescriptions, please call Member Services at 833.276.8306 (toll-free) or 713.295.5007 (local). TTY users should call 711.
For questions about taking your prescriptions, please call your local pharmacy.
You can enroll in D-SNP year-round. If you already have Medicare and Medicaid, you may qualify for D-SNP.
For questions about eligibility and enrollment, please visit our eligibility page or give us a call at 833.276.8306 (TTY 711).
Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed to meet the specific needs of dually eligible beneficiaries – those who are entitled to both Medicare and medical assistance from a state plan under Medicaid.
Our HMO D-SNP plan has a $0 premium, a $0 deductible, and a $0 copay.
If Covered Services are not available through in-network Participating Physicians or Providers, you or your doctor may request prior authorization for Covered Services by a doctor or other provider outside the contracted network. If covered services are approved, then you are only responsible for your share of the cost, if any, that you may have paid if you could obtain services from Community’s network of participating providers. If you receive a bill from an out-of-network provider, contact Member Services for assistance.
Use the information on our Find a Doctor page. If you don’t see your Primary Care Provider listed, call Community at 1.888.760.2600 (toll-free). We add new doctors all the time.
In most cases, you will need to get a referral from your primary care provider to see a specialist.
Your Primary Care Provider will refer you to a hospital if you need non-emergency hospital care. Community Health Choice will not pay the cost of non-emergency hospital care or medical equipment unless your Primary Care Provider gives you a referral.
Members with disabilities, special healthcare needs, and chronic or complex conditions may have direct access to a specialist.
The Community Health Choice HMO D-SNP dental coverage includes up to [$3,500] in benefit allowance for dental services (routine and comprehensive combined) every year. See the Evidence of Coverage [link to 2023 EOC] for more information on covered and non-covered dental services.
Using an in-network pharmacy is important. You will pay more for your prescription drugs if you go to an out-of-network pharmacy. Use our online pharmacy directory find an in-network pharmacy:
You can also use the mail order pharmacy program. Benefits are provided through Novixus Mail Order Pharmacy. To enroll online, go to Novixus.com and choose “Mail Order Pharmacy” or call Novixus toll-free at 1.888.240.2211.
If your drug is not included in this formulary, you have two options:
October 1 to March 31, 8:00 am to 8:00 pm, 7 days a week, and April 1 through September 30, 8:00 am to 8:00 pm, Monday through Friday. On certain holidays your call will be handled by our automated phone system.