Senior Care Plus Essential plan (HMO)
Available to residents of Washoe County, NV for 2026. Contract H2960, plan 012, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Washoe County
- Plan website
- Browse the Senior Care Plus Essential plan (HMO) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $2,700.00? |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO? |
| Contract / plan | H2960-012-0 |
| Offered by | Senior Care Plus |
| Parent organization | Renown Health |
| Formulary drugs | 3,478 |
| Formulary exception tier | 4? |
| Pharmacy search | www.SeniorCarePlus.com |
| Member services | (888)775-7003TTY 711 |
CMS star ratings
- Overall
- 5 out of 5 stars for Overall
- Health plan (Part C)
- 5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H2960 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0–$10 copay |
| Specialist | $30 copay |
| Other health care professional | $30 copay(authorization required) |
| Additional telehealth services | $0 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay(referral required) |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$275 copay |
| Lab services | $0–$120 copay |
| Diagnostic radiology (e.g. MRI, CT) | $0–$100 copay(referral required) |
| Therapeutic radiology | $80 copay(referral required) |
| Outpatient x-rays | $35 copay(referral required) |
| Emergency and urgent care | |
| Emergency room | $140 copay |
| Urgent care | $20–$65 copay |
| Worldwide emergency coverage | $140 copay · $10,000 plan limit |
| Worldwide urgent care | $65 copay · $10,000 plan limit |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $220 per day for days 1–4; $0 per day for days 5–90; varies by hospital tier(authorization and referral required) |
| Outpatient hospital services | $0–$440 copay |
| Outpatient observation | $300–$440 copay(authorization required) |
| Ambulatory surgical center | $0–$440 copay(authorization and referral required) |
| Outpatient blood services | 20% coinsurance |
| Skilled nursing and home health | |
| Skilled nursing facility | $20 per day for days 1–20; $200 per day for days 21–34; $0 per day for days 35–100(authorization required) |
| Home health care | $0 copay(referral required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $25 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $25 copay(authorization required) |
| Cardiac rehabilitation | $15 copay |
| Pulmonary rehabilitation | $20 copay |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $220 per day for days 1–4; $0 per day for days 5–90; varies by hospital tier(authorization and referral required) |
| Outpatient mental health, individual session | $30 copay |
| Outpatient mental health, group session | $30 copay |
| Psychiatrist, individual session | $30 copay(referral required) |
| Psychiatrist, group session | $30 copay(referral required) |
| Partial hospitalization | $130 copay(referral required) |
| Intensive outpatient program | $75 copay(authorization required) |
| Outpatient substance use, individual session | $50 copay |
| Outpatient substance use, group session | $50 copay |
| Opioid treatment program | $50 copay(referral required) |
| Ambulance and transportation | |
| Ground ambulance | $275 copay(authorization required) |
| Air ambulance | $275 copay(authorization required) |
| Transportation to plan-approved locations | $0 copay(authorization and referral required, limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 0%–20% coinsurance |
| Diabetic therapeutic shoes or inserts | 20% coinsurance |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $20 copay |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $30 copay |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $40 copay |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | Not covered |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $30 copay(limits apply) |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | 20% coinsurance(limits apply) |
| Eyewear plan limit | $250 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $45 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay(limits apply) |
| Hearing aids (all types) | $495–$1,970 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $50 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(authorization required) |
| Health education | $0 copay(authorization required) |
| Nutritional / dietary benefit | $0 copay(authorization required) |
| Extra smoking and tobacco cessation counseling | $0 copay(authorization required) |
| Enhanced disease management | Not covered |
| Telemonitoring | $0 copay(authorization required) |
| Remote access technologies (web/phone, nurse line) | $0 copay(authorization required) |
| Home and bathroom safety devices | $0 copay(authorization required) |
| Counseling services | Not covered |
| In-home safety assessment | $0 copay(authorization required) |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $5.00 |
| Tier 2 | $12.00 |
| Tier 3 | $47.00 |
| Tier 4 | 50% |
| Tier 5 | 33% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $5.00 | $5.00 | n/a | $12.50 | $12.50 | $10.00 |
| Tier 2: Generic | $12.00 | $12.00 | n/a | $30.00 | $30.00 | $24.00 |
| Tier 3: Preferred Brand | $47.00 | $47.00 | n/a | $117.50 | $117.50 | $94.00 |
| Tier 4: Non-Preferred Drug | 50% | 50% | n/a | 50% | 50% | 50% |
| Tier 5: Specialty Tier | 33% | 33% | n/a | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 2 other NV counties
Benefits in plain text
Senior Care Plus Essential plan (HMO) (H2960-012-0) is a 2026 HMO Medicare Advantage plan offered by Senior Care Plus, available to residents of Washoe County, NV.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $2,700.00.
The drug deductible is $0.00.
The plan's formulary lists 3,478 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $5.00; tier 2: $12.00; tier 3: $47.00; tier 4: 50%; tier 5: 33%; tier 6: $0.00.
CMS gives the plan's contract (H2960) an overall rating of 5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.