Frequently Asked Questions

What is a Dual Eligible Special Needs Plan (D-SNP)?

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.

Why should I enroll in a D-SNP?

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.

How do I know if I'm eligible?

You qualify for Community Health Choice (HMO D-SNP) if:
  • You’re currently enrolled in Medicare Parts A and B.
  • You’re currently eligible for full Medicaid benefits.
  • You live in the Community Health Choice service area.
  • You are 21 years of age or older.
  • You are 65 or older with a qualifying income.
  • You are 21 or older with a qualifying disability.
Visit the eligibility page for more information or call Member Services to speak with a representative.

How do I apply?

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.


How do I contact Community Health Choice?

Call us toll-free at 833.276.8306 o713.295.5007 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.

How do I check if my doctor is in the Community Health Choice network?

You can search for doctors in the Community Health Choice (HMO D-SNP) plan or call Member Services to assist you.

Who do I call if I need care advice?

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. 

Who do I call if I have problems with my prescriptions?

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. 

When can I enroll in a D-SNP?

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).

How do HMO D-SNP plans work?

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.

How much do I pay for HMO D-SNP coverage?

Our HMO D-SNP plan has a $0 premium, a $0 deductible, and a $0 copay.

Does HMO D-SNP provide coverage – including doctors and pharmacies – outside my home area?

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.

How do I choose my Primary Care Provider (PCP)?

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. 

Do I need to see my Primary Care Provider to get referral?

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.

  • Emergency care 
  • OB/GYN care
  • Texas Health Steps medical and dental checkups
  • Family planning services
  • Behavioral (mental) health services or drug and alcohol treatment

Members with disabilities, special healthcare needs, and chronic or complex conditions may have direct access to a specialist.

Does HMO D-SNP include dental coverage?

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.

Where can I get my prescriptions filled?

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:

  1. Go to CHC Medicare
  2. From the menu on the right, select Find a Doctor or Pharmacy
  3. Click Next (lower right-hand corner) to get started
  4. Click on D-SNP, then click Next
  5. Enter your zip code, then click Validate Address. Once your address is validated, click Next
  6. Select a Provider; Click on Pharmacies and then Next to see a list of pharmacies within five miles of your home.

You can also use the mail order pharmacy program. Benefits are provided through Novixus Mail Order Pharmacy. To enroll online, go to and choose “Mail Order Pharmacy” or call Novixus toll-free at 1.888.240.2211.

What is the Community Health Choice (HMO D-SNP) Formulary?

A formulary is a list of covered drugs selected by Community Health Choice. Click here for the current drug list.

What if my drug isn’t on the formulary?

If your drug is not included in this formulary, you have two options:

  • You can ask Member Services at 833.276.8306 (toll-free) or 711 (TTY) for a list of similar drugs that are covered by Community Health Choice. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Community Health Choice.
  • You can ask Community Health Choice to make an exception and cover your drug. Contact Member Services for more information.
  • If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in Community’s Medication Therapy Management (MTM) program at no additional cost to you. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.


Still have questions?

Speak to a Community Health Choice Medicare plan specialist by calling:

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.


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

H9826_MK_10331_100422_M. Last updated October 4, 2022.