Clear Spring Health Silver Plan (HMO C-SNP) Costs & Coverage, Lamar County, Georgia
Clear Spring Health Silver Plan (HMO C-SNP) Costs & Coverage, Lamar County, Georgia
Uncover the tailored benefits and costs of Clear Spring Health Silver Plan (HMO C-SNP), a 2025 Medicare Special Needs Plan crafted to support your specific healthcare requirements This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Clear Spring Health are different than Original Medicare. This private health insurance option, available to qualified individuals in Lamar County, GA, may include additional benefits that are not provided by Medicare Part A and Part B.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Clear Spring Health logo is a registered trademark.[2]
| Feature | Details |
|---|---|
| Health Plan ID: | H6672-003-0 |
| Medicare Advantage Plan Type: | HMO C-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6,751.00 |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $250.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Lamar County, GA |
| Insured By: | Clear Spring Health |
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Health Plan Cost Sharing & Benefits
Clear Spring Health Silver Plan is a Health Maintenance Organization (HMO) plan. As an HMO member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Clear Spring Health Silver Plan does cover out-of-network care for emergencies and out-of-area dialysis.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | $25 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $80 Copay |
| Urgent care: | $45 Copay |
| Ground ambulance: | $225 Copay |
| Inpatient hospital care: | $300.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $167.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $30 Copay |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
| Routine chiropractic: | $15 Copay Prior Authorization Required |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $30 Copay |
| Outpatient group therapy: | $30 Copay |
| Inpatient psychiatric hospital care: | $300.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $40 Copay Prior Authorization Required |
| Occupational therapy: | $35 Copay Prior Authorization Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | 20% Coinsurance |
| Lab services: | Not Covered |
| Outpatient x-rays: | $25 Copay |
| Diagnostic tests and procedures: | 20% Coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $30 Copay |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $30 Copay |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: No Eyeglass Lenses: No Eyeglass Frames: No Eyewear Upgrades: No |
Maximum eyewear benefit: | $250.00 Every year |
Do you have questions about the costs in this plan? Call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this Special Needs Plan (H6672-003-0) and other plans on this site.
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $39.99 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $250.00. This is the amount you must pay at the pharmacy before Clear Spring Health begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Clear Spring Health Silver Plan has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $5.00 |
| Generic* | $0.00 | $20.00 |
| Preferred Brand | $42.00 | $47.00 |
| Non-Preferred Drug | $95.00 | $100.00 |
| Specialty Tier | 29.00% | 29.00% |
| *Deductible does not apply. | ||
CMS Rating Marks
Each year, Medicare Advantage HMO C-SNPs are rated by the Centers for Medicare & Medicaid Services (CMS) across nine categories using a 5-star system. These star ratings are designed to help you assess the quality of care and service offered by this Clear Spring Health plan.
CMS Star Ratings for Plan H6672-003-0 – 2025
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing | Not enough data available |
Eligibility Criteria for Enrolling in Clear Spring Health Silver Plan
To enroll in Clear Spring Health Silver Plan , you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.
SNP Plan Enrollment Periods
Once you’ve confirmed your eligibility for Clear Spring Health Silver Plan , it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll when you become eligible for Medicare.
- Annual Enrollment Period (AEP): The time each year when you can change your Medicare plan or enroll in a new one.
- Special Enrollment Periods (SEPs): Times outside of AEP when you can make changes due to specific circumstances, such as moving to a new area or losing other insurance coverage.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Clear Spring Health
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | Clear Spring Health Plan Page |
| Providers: | Clear Spring Health Providers Page |
| Formulary: | Clear Spring Health Formulary Page |
| Pharmacy: | Clear Spring Health Pharmacy Page |
| New Member Health Plan Help: | (877)248-6622 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (877)248-6622 |
| New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
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Clear Spring Health Official Plan Details – 2025
Official webpage by Clear Spring Health detailing the Aetna Medicare Preferred (HMO D-SNP) plan benefits, coverage, and enrollment options.
Source Webpage: https://www.clearspringhealthcare.com -
CMS Medicare Advantage and Prescription Drug Plan Landscape Files – 2025
Official CMS dataset detailing Medicare Advantage and Prescription Drug plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: cy2025-landscape-202412.zip
Source Webpage: CMS Medicare Coverage: Prescription Drug Coverage -
CMS Medicare Star Ratings Data Tables – 2025
Official CMS Star Ratings dataset providing performance ratings for Medicare plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: 2025-star-ratings-data-tables.zip
Source Webpage: CMS Part C and D Performance Data -
CMS Plan Benefits Package (PBP) Files – 2025
Official CMS dataset providing detailed plan benefit information for Medicare Advantage plans in 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: pbp-benefits-2025.zip
Source Webpage: CMS Medicare Advantage and Part D Benefits Data