Sentara Community Complete (HMO D-SNP)

Available to residents of Charles City County, VA for 2027. Contract H4499, plan 001, segment 0.

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 VA plan’s 2026–2027 changes →

Plan details

Monthly premium (Part C + D)	$6.30
— medical (Part C) part	$0.00
— drug (Part D) part	$6.30?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,850.00?
Drug deductible	$700.00Tier 1 exempt
Drug out-of-pocket threshold	$2,400.00
Plan type	HMO D-SNP?
Special needs plan	Dual-eligible SNP
D-SNP integration status	Fully Integrated (FIDE)
Zero-dollar cost sharing D-SNP	Yes
Contract / plan	H4499-001-0
Offered by	Sentara Medicare
Parent organization	Sentara Health Care (SHC)
Formulary tiers	4
Formulary exception tier	3?
Pharmacy search	www.sentarahealthplans.com/providers/pharmacy
Member services	(844)563-4201TTY (800)828-1120

CMS star ratings

Overall: 3 out of 5 stars for Overall
Health plan (Part C): 3 out of 5 stars for 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 H4499 shares this rating.

Plan health benefits

Service	In-network
Doctor visits
Primary care doctor	20% coinsurance
Specialist	20% coinsurance(authorization required)
Other health care professional	20% coinsurance(authorization required)
Additional telehealth services	Not covered
Preventive care
Medicare-covered preventive services	$0 copay(authorization required)
Annual physical exam	$0 copay
Kidney disease education	20% coinsurance(authorization required)
Glaucoma screening	20% coinsurance(authorization required)
Diabetes self-management training	20% coinsurance(authorization required)
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	20% coinsurance(authorization required)
Lab services	20% coinsurance(authorization required)
Diagnostic radiology (e.g. MRI, CT)	20% coinsurance(authorization required)
Therapeutic radiology	20% coinsurance(authorization required)
Outpatient x-rays	20% coinsurance(authorization required)
Emergency and urgent care
Emergency room	20% coinsurance
Urgent care	20% coinsurance
Worldwide emergency coverage	$0 copay · $100,000 plan limit
Worldwide urgent care	$0 copay · $100,000 plan limit
Worldwide emergency transportation	$0 copay
Hospital care
Inpatient hospital stay	Original Medicare cost-sharing(authorization required)
Outpatient hospital services	20% coinsurance(authorization required)
Outpatient observation	20% coinsurance(authorization required)
Ambulatory surgical center	20% coinsurance(authorization required)
Outpatient blood services	20% coinsurance(authorization required)
Skilled nursing and home health
Skilled nursing facility	Original Medicare cost-sharing(authorization required)
Home health care	$0 copay(authorization required)
Kidney dialysis	20% coinsurance
Rehabilitation
Occupational therapy	20% coinsurance(authorization required)
Physical therapy and speech-language therapy	20% coinsurance(authorization required)
Cardiac rehabilitation	20% coinsurance(authorization required)
Pulmonary rehabilitation	20% coinsurance(authorization required)
Mental health and substance use
Inpatient psychiatric hospital stay	Original Medicare cost-sharing(authorization required)
Outpatient mental health, individual session	20% coinsurance(authorization required)
Outpatient mental health, group session	20% coinsurance(authorization required)
Psychiatrist, individual session	20% coinsurance(authorization required)
Psychiatrist, group session	20% coinsurance(authorization required)
Partial hospitalization	20% coinsurance(authorization required)
Intensive outpatient program	20% coinsurance(authorization required)
Outpatient substance use, individual session	20% coinsurance(authorization required)
Outpatient substance use, group session	20% coinsurance(authorization required)
Opioid treatment program	20% coinsurance(authorization required)
Ambulance and transportation
Ground ambulance	20% coinsurance(authorization required)
Air ambulance	20% coinsurance(authorization required)
Transportation to plan-approved locations	Not covered
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	20% coinsurance(authorization required)
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	20% coinsurance(authorization required)
Routine chiropractic care	$0 copay(authorization required, limits apply)
Acupuncture	Not covered
Foot exams and treatment (Medicare-covered)	20% coinsurance(authorization required)
Routine foot care	$0 copay(authorization required, limits apply)
Dental?
Medicare-covered dental services	20% coinsurance(authorization required)
Oral exams	$0 copay(limits apply)
Cleanings	$0 copay(limits apply)
Fluoride treatment	$0 copay(limits apply)
Dental x-rays	$0 copay(limits apply)
Other diagnostic dental services	Not covered
Other preventive dental services	Not covered
Comprehensive dental plan limit	$4,000 plan limit every year
Restorative services (fillings, crowns)	$0 copay(authorization required, limits apply)
Endodontics (root canals)	$0 copay(authorization required, limits apply)
Periodontics (gum disease)	$0 copay(authorization required, limits apply)
Dentures and other removable prosthodontics	$0 copay(authorization required, limits apply)
Maxillofacial prosthetics	Not covered
Implants	Not covered
Bridges and other fixed prosthodontics	Not covered
Oral and maxillofacial surgery	$0 copay(authorization required)
Orthodontics	Not covered
Adjunctive general services	$0 copay(authorization required)
Vision?
Eye exam (Medicare-covered)	20% coinsurance
Routine eye exam	$0 copay(limits apply)
Eyewear after cataract surgery (Medicare-covered)	20% coinsurance(limits apply)
Eyewear plan limit	$400 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)	20% coinsurance(authorization required)
Routine hearing exam	$0 copay(authorization required, limits apply)
Hearing aid fitting and evaluation	$0 copay(authorization required, limits apply)
Hearing aid plan limit	$2,000 plan limit every year
Hearing aids (all types)	$0 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	$355 allowance every month
Meals after a hospital stay or for a chronic condition	Not covered
Fitness benefit	$0 copay(authorization required, limits apply)
Health education	$0 copay(authorization required, limits apply)
Nutritional / dietary benefit	$0 copay(authorization required, limits apply)
Extra smoking and tobacco cessation counseling	$0 copay(authorization required, limits apply)
Enhanced disease management	$0 copay(authorization required, limits apply)
Telemonitoring	Not covered
Remote access technologies (web/phone, nurse line)	$0 copay(authorization required, limits apply)
Home and bathroom safety devices	$0 copay(authorization required, limits apply)
Counseling services	Not covered
In-home safety assessment	Not covered
Personal emergency response system (PERS)	$0 copay(authorization required, limits apply)
Medical nutrition therapy	Not covered
Post-discharge in-home medication reconciliation	Not covered
Re-admission prevention	$0 copay(authorization 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	$0 copay(authorization required, limits apply)
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	25%
Tier 3 · Preferred Brand	25%
Tier 4 · Specialty Tier	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	25%	25%	25%	25%	25%	25%
Tier 3: Preferred Brand	25%	25%	25%	25%	25%	25%
Tier 4: Specialty Tier	25%	25%	25%	n/a	n/a	n/a

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

Each CMS star measure for contract H4499, 2027 against 2026
Measure	2027	2026
Staying Healthy: Screenings, Tests and Vaccines
Breast Cancer Screening · C01	2 out of 5 stars for Breast Cancer Screening	too new
Colorectal Cancer Screening · C02	1 out of 5 stars for Colorectal Cancer Screening	too new
Annual Flu Vaccine · C03	2 out of 5 stars for Annual Flu Vaccine	too new
Managing Chronic (Long Term) Conditions
Special Needs Plan (SNP) Care Management · C07	2 out of 5 stars for Special Needs Plan (SNP) Care Management	too new
Care for Older Adults – Medication Review · C08	2 out of 5 stars for Care for Older Adults – Medication Review	too new
Care for Older Adults - Functional Status Assessment · C09	2 out of 5 stars for Care for Older Adults - Functional Status Assessment	new measure
Diabetes Care – Eye Exam · C11	1 out of 5 stars for Diabetes Care – Eye Exam	too new
Diabetes Care – Blood Sugar Controlled · C12	2 out of 5 stars for Diabetes Care – Blood Sugar Controlled	too new
Kidney Health Evaluation for Patients with Diabetes · C13	1 out of 5 stars for Kidney Health Evaluation for Patients with Diabetes	too new
Controlling High Blood Pressure · C14	1 out of 5 stars for Controlling High Blood Pressure	too new
Plan All-Cause Readmissions · C17	3 out of 5 stars for Plan All-Cause Readmissions	too new
Statin Therapy for Patients with Cardiovascular Disease · C18	2 out of 5 stars for Statin Therapy for Patients with Cardiovascular Disease	too new
Transitions of Care · C19	2 out of 5 stars for Transitions of Care	too new
Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions · C20	1 out of 5 stars for Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions	too new
Member Experience with Health Plan
Getting Needed Care · C21	3 out of 5 stars for Getting Needed Care	too new
Getting Appointments and Care Quickly · C22	5 out of 5 stars for Getting Appointments and Care Quickly	too new
Customer Service · C23	4 out of 5 stars for Customer Service	too new
Rating of Health Care Quality · C24	3 out of 5 stars for Rating of Health Care Quality	too new
Rating of Health Plan · C25	5 out of 5 stars for Rating of Health Plan	too new
Care Coordination · C26	3 out of 5 stars for Care Coordination	too new
Member Complaints and Changes in the Health Plan's Performance
Complaints about the Health Plan · C27	4 out of 5 stars for Complaints about the Health Plan	too new
Members Choosing to Leave the Plan · C28	4 out of 5 stars for Members Choosing to Leave the Plan	not enough data
Health Plan Customer Service
Plan Makes Timely Decisions about Appeals · C30	2 out of 5 stars for Plan Makes Timely Decisions about Appeals	not enough data
Reviewing Appeals Decisions · C31	2 out of 5 stars for Reviewing Appeals Decisions	not enough data
Call Center – Foreign Language Interpreter and TTY Availability · C32	4 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
DD1: Drug Plan Customer Service
Call Center – Foreign Language Interpreter and TTY Availability · D01	5 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
Complaints about the Drug Plan · D02	4 out of 5 stars for Complaints about the Drug Plan	too new
Members Choosing to Leave the Plan · D03	4 out of 5 stars for Members Choosing to Leave the Plan	not enough data
DD3: Member Experience with the Drug Plan
Rating of Drug Plan · D05	4 out of 5 stars for Rating of Drug Plan	too new
Getting Needed Prescription Drugs · D06	4 out of 5 stars for Getting Needed Prescription Drugs	too new
DD4: Drug Safety and Accuracy of Drug Pricing
MPF Price Accuracy · D07	5 out of 5 stars for MPF Price Accuracy	too new
Medication Adherence for Diabetes Medications · D08	2 out of 5 stars for Medication Adherence for Diabetes Medications	too new
Medication Adherence for Hypertension (RAS antagonists) · D09	2 out of 5 stars for Medication Adherence for Hypertension (RAS antagonists)	too new
Medication Adherence for Cholesterol (Statins) · D10	2 out of 5 stars for Medication Adherence for Cholesterol (Statins)	too new
Statin Use in Persons with Diabetes (SUPD) · D11	2 out of 5 stars for Statin Use in Persons with Diabetes (SUPD)	too new
Concurrent Use of Opioids and Benzodiazepines (COB) · D12	3 out of 5 stars for Concurrent Use of Opioids and Benzodiazepines (COB)	new measure
Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) · D13	1 out of 5 stars for Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)	new measure

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 H4499 shares it.

Benefits in plain text

Sentara Community Complete (HMO D-SNP) (H4499-001-0) is a 2027 HMO D-SNP Medicare Advantage plan offered by Sentara Medicare, available to residents of Charles City County, VA.

The monthly premium is $6.30.

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,850.00.

The drug deductible is $700.00. Tier 1 exempt.

It is a special needs plan (Dual-eligible SNP).

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1 (Preferred Generic): $0.00; tier 2 (Generic): 25%; tier 3 (Preferred Brand): 25%; tier 4 (Specialty Tier): 25%.

CMS gives the plan's contract (H4499) an overall rating of 3 out of 5 stars.

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.