Sentara Community Complete (HMO D-SNP) Costs & Coverage, Floyd County, Virginia
Sentara Community Complete (HMO D-SNP) Costs & Coverage, Floyd County, Virginia
Discover how Sentara Community Complete (HMO D-SNP) stands out as a 2026 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. 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 Sentara Medicare are different than Original Medicare. This private health insurance option, available to qualified individuals in Floyd County, VA, may include additional benefits that are not provided by Medicare Part A and Part B.
As of May 31, 2025, plan enrollments topped 8,489 members, with 26 in Floyd County, Virginia.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Sentara Medicare logo is a registered trademark.[2]
Sentara Community Complete Overview
| Plan ID H4499-001-0 Overview | |
|---|---|
| Health Plan ID: | H4499-001-0 |
| Medicare Advantage Plan Type: | HMO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $16.20 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Floyd County, VA |
| Insured By: | Sentara Medicare |
We're Here to Help You Enroll
Health Plan Cost Sharing & Benefits
Sentara Community Complete 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, Sentara Community Complete 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: | In-network: $0 copay | Out-of-network: $0 copay |
| Specialist: | In-network: $0 copay | Out-of-network: $0 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | Not covered |
| Routine chiropractic: | In-network: $0 copay |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 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: | $0 copay |
| Wordwide emergency care: | $0 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $0 per day for days 1-60 | $0 per day for days 61-90 | $0 per day for days 91-150 |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $209.5 per day for days 21-100 |
| Ground ambulance: | In-network: $0 copay | Out-of-network: $0 copay |
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: | In-network: $0 copay | Out-of-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per day for days 1-60 | $0 per day for days 61-90 | $0 per day for days 91-150 |
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: | In-network: $0 copay | Out-of-network: $0 copay |
| Occupational therapy: | In-network: $0 copay | Out-of-network: $0 copay |
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: | In-network: $0 copay | Out-of-network: $0 copay |
| Durable medical equipment: | In-network: $0 copay | Out-of-network: $0 copay |
| Prosthetics: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0 copay | Out-of-network: $0 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: $0 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: $0 copay | Out-of-network: $0 copay |
| Other Part B drugs (Medicare-covered): | In-network: $0 copay | Out-of-network: $0 copay |
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) |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | In-network: $0 copay |
| Restorative services: | In-network: $0 copay |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay |
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 (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this Special Needs Plan (H4499-001-0) 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: | $16.20 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $16.20 |
| Low Income Premium Subsidy: | $24.56 |
| Low Income Premium Subsidy CMS Pays: | $16.20 |
| 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 $615.00. This is the amount you must pay at the pharmacy before Sentara Medicare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Sentara Community Complete 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 |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year, Medicare Advantage HMO D-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 Sentara Medicare plan.
CMS Star Ratings for Plan H4499-001-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
How to Qualify for Enrollment in Sentara Community Complete
To enroll in Sentara Community Complete you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for Sentara Community Complete, it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- 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 comprehensive information on these enrollment periods, learn more here and make well-informed Medicare decisions.
Contact Sentara Medicare
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | Sentara Medicare Plan Page |
| New Members: | 1-844-563-4201 |
| Existing Members: | 1-866-650-1274 |
| Plan Address: | 1300 Sentara Park | Virginia Beach, VA 23464 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 15, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Sentara Medicare, http://www.sentarahealthplans.com/medicare — Last accessed October 13, 2025
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)" — Last accessed September 20, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 5 May, 2025
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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.