Community y Más (HMO C-SNP)
Available to residents of San Diego County, CA for 2027. Contract H6248, plan 001, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in San Diego County
- Plan website
- Browse the Community y Más (HMO C-SNP) formulary
2027 drug-by-drug coverage is not published by CMS yet. The drug lookup covers 2026, whose formulary is live.
Renewed for 2027. CMS carries this plan forward from 2026. Every CA plan’s 2026–2027 changes →
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 | $1,500.00? |
| Drug deductible | $700.00Tier 1, 2 and 6 exempt |
| Drug out-of-pocket threshold | $2,400.00 |
| Plan type | HMO C-SNP? |
| Special needs plan | Chronic-condition SNP |
| Qualifying condition | CardiovascularDisorders,ChronicHeartFailure,DiabetesMellitus |
| Contract / plan | H6248-001-0 |
| Offered by | Community Health Group |
| Parent organization | Community Health Group |
| Formulary tiers | 6 |
| Formulary exception tier | 4? |
| Pharmacy search | www.chgsd.com/ |
| Member services | (800)232-3133TTY (855)266-4584 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- 3 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H6248 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay |
| Other health care professional | $0 copay |
| Additional telehealth services | Not covered |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | Not covered |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0 copay |
| Lab services | $0 copay |
| Diagnostic radiology (e.g. MRI, CT) | $0–$75 copay(authorization required) |
| Therapeutic radiology | $0 copay(authorization required) |
| Outpatient x-rays | $0 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $140 copay |
| Urgent care | $0 copay |
| Worldwide emergency coverage | $140 copay · $50,000 plan limit |
| Worldwide urgent care | $140 copay · $50,000 plan limit |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $75 per day for days 1–3; $0 per day for days 4–90 |
| Outpatient hospital services | $75 copay(authorization and referral required) |
| Outpatient observation | $75 copay(referral required) |
| Ambulatory surgical center | $0 copay(authorization and referral required) |
| Outpatient blood services | $0 copay(authorization and referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $200 per day for days 21–100(authorization and referral required) |
| Home health care | $0 copay(authorization and referral required) |
| Kidney dialysis | $0 copay |
| Rehabilitation | |
| Occupational therapy | $0 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $0 copay(authorization and referral required) |
| Cardiac rehabilitation | $0 copay(authorization and referral required) |
| Pulmonary rehabilitation | $0 copay(authorization and referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $75 per day for days 1–3; $0 per day for days 4–90 |
| Outpatient mental health, individual session | $0 copay(authorization and referral required) |
| Outpatient mental health, group session | $0 copay(authorization and referral required) |
| Psychiatrist, individual session | $0 copay(authorization and referral required) |
| Psychiatrist, group session | $0 copay(authorization and referral required) |
| Partial hospitalization | $0 copay(referral required) |
| Intensive outpatient program | $0 copay |
| Outpatient substance use, individual session | $0 copay(authorization and referral required) |
| Outpatient substance use, group session | $0 copay(authorization and referral required) |
| Opioid treatment program | $0 copay(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $150 copay(authorization required) |
| Air ambulance | $150 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) | 15% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 15% coinsurance(authorization required) |
| Medical supplies | 15% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | $0 copay(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay(authorization and referral required) |
| Routine chiropractic care | $0 copay(authorization and referral required, limits apply) |
| Acupuncture | $0 copay(authorization and referral required, limits apply) |
| Foot exams and treatment (Medicare-covered) | $0 copay(authorization and referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $0 copay(referral required) |
| Oral exams | $0 copay(referral required, limits apply) |
| Cleanings | $0 copay(referral required, limits apply) |
| Fluoride treatment | $0 copay(referral required, limits apply) |
| Dental x-rays | $0 copay(referral required, limits apply) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Comprehensive dental plan limit | $2,000 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay |
| Endodontics (root canals) | $0 copay |
| Periodontics (gum disease) | $0 copay |
| Dentures and other removable prosthodontics | $0 copay(referral required) |
| Maxillofacial prosthetics | $0 copay |
| Implants | $0 copay(referral required) |
| Bridges and other fixed prosthodontics | $0 copay(referral required) |
| Oral and maxillofacial surgery | $0 copay |
| Orthodontics | $0 copay |
| Adjunctive general services | $0 copay |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Eyewear plan limit | $300 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay(referral required) |
| Routine hearing exam | $0 copay(referral required, limits apply) |
| Hearing aid fitting and evaluation | $0 copay(referral required, limits apply) |
| Hearing aid plan limit | $750 plan limit every three years |
| Hearing aids (all types) | $0 copay(authorization and referral required, 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) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required) |
| Other Part B drugs | 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $145 allowance every three months |
| Meals after a hospital stay or for a chronic condition | $0 copay(authorization and referral required) |
| Fitness benefit | $0 copay(authorization and referral required, limits apply) |
| Health education | $0 copay(authorization and referral required, limits apply) |
| Nutritional / dietary benefit | $0 copay(authorization and referral required, limits apply) |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | $0 copay(authorization and referral required, limits apply) |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay(authorization and referral required, limits apply) |
| Home and bathroom safety devices | $0 copay(authorization and referral required, limits apply) |
| Counseling services | Not covered |
| In-home safety assessment | $0 copay(authorization and referral required, limits apply) |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | $0 copay(authorization and referral required, limits apply) |
| Re-admission prevention | $0 copay(authorization and referral required, limits apply) |
| 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, CY2027). 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 · Preferred Generic | $0.00 |
| Tier 2 · Generic | $9.00 |
| Tier 3 · Preferred Brand | $47.00 |
| Tier 4 · Non-Preferred Brand | 30% |
| Tier 5 · Specialty Tier | 25% |
| Tier 6 · Select Care Drugs | $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 | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $9.00 | $9.00 | n/a | $27.00 | $27.00 | $27.00 |
| Tier 3: Preferred Brand | $47.00 | $47.00 | n/a | $141.00 | $141.00 | $141.00 |
| Tier 4: Non-Preferred Brand | 30% | 30% | n/a | 30% | 30% | 30% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | $0.00 | $0.00 | $0.00 |
These are the initial coverage phase amounts, as the plan filed them in its benefit package. The deductible and post-threshold phases are not stated per tier in that filing, so they are not shown here rather than being inferred; the plan's annual out-of-pocket threshold is $2,400.00.
Star rating measures
| Measure | 2027 | 2026 |
|---|---|---|
| Managing Chronic (Long Term) Conditions | ||
| Special Needs Plan (SNP) Care Management · C07 | 1 out of 5 stars for Special Needs Plan (SNP) Care Management | 1 out of 5 stars for Special Needs Plan (SNP) Care Management |
| Care for Older Adults – Medication Review · C08 | 3 out of 5 stars for Care for Older Adults – Medication Review | 2 out of 5 stars for Care for Older Adults – Medication Review |
| Care for Older Adults - Functional Status Assessment · C09 | 3 out of 5 stars for Care for Older Adults - Functional Status Assessment | new measure |
| Health Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · C32 | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD1: Drug Plan Customer Service | ||
| Call Center – Foreign Language Interpreter and TTY Availability · D01 | 3 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability | 4 out of 5 stars for Call Center – Foreign Language Interpreter and TTY Availability |
| DD2: Member Complaints and Changes in the Drug Plan’s Performance | ||
| Drug Plan Quality Improvement · D04 | 5 out of 5 stars for Drug Plan Quality Improvement | not enough data |
| DD4: Drug Safety and Accuracy of Drug Pricing | ||
| MPF Price Accuracy · D07 | 5 out of 5 stars for MPF Price Accuracy | 4 out of 5 stars for MPF Price Accuracy |
| Medication Adherence for Diabetes Medications · D08 | 2 out of 5 stars for Medication Adherence for Diabetes Medications | 1 out of 5 stars for Medication Adherence for Diabetes Medications |
| Medication Adherence for Hypertension (RAS antagonists) · D09 | 2 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) | 1 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists) |
| Medication Adherence for Cholesterol (Statins) · D10 | 1 out of 5 stars for Medication Adherence for Cholesterol (Statins) | 2 out of 5 stars for Medication Adherence for Cholesterol (Statins) |
| Statin Use in Persons with Diabetes (SUPD) · D11 | 3 out of 5 stars for Statin Use in Persons with Diabetes (SUPD) | not enough data |
Measures are paired between the two years by name, not by the C/D number: CMS reuses those numbers, and in 2027 nineteen of them refer to a different measure than they did in 2026. A measure introduced for 2027 has no 2026 score to show. Published per contract — every plan under H6248 shares it.
Benefits in plain text
Community y Más (HMO C-SNP) (H6248-001-0) is a 2027 HMO C-SNP Medicare Advantage plan offered by Community Health Group, available to residents of San Diego County, CA.
The monthly premium is $0.00.
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 $1,500.00.
The drug deductible is $700.00. Tier 1, 2 and 6 exempt.
It is a special needs plan (Chronic-condition SNP).
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): $9.00; tier 3 (Preferred Brand): $47.00; tier 4 (Non-Preferred Brand): 30%; tier 5 (Specialty Tier): 25%; tier 6 (Select Care Drugs): $0.00.
Email a copy of the plan benefit details
Plan facts come from the CMS plan Landscape file and the CMS plan benefit package (PBP) files.