Dual Special Needs Plan
(D-SNP) Service Area
This plan is designed to meet the special needs of those who are eligible for both Medicare and Medicaid. You must be eligible for Medicare and Medicaid in order to enroll in FirstCare Advantage Dual SNP (HMO SNP). Ask if you qualify to enroll in FirstCare's Special Needs Plan designed for Medicare and Medicaid beneficiaries.
FirstCare Advantage Dual SNP (HMO SNP) serves the following counties in Texas:
Carson, Crosby, Deaf Smith, Floyd, Garza, Hale, Hockley, Hutchinson, Lamb, Lubbock, Lynn, Potter, Randall, Swisher, and Terry
FirstCare Low Income Subsidy (LIS) Premium Summary Chart
2020
FirstCare Advantage Dual SNP LIS Premium Summary Chart
First Care Advantage Dual SNP LIS Premium Summary Chart - Version en Español
2019
FirstCare Advantage Dual SNP LIS Premium Summary Chart
First Care Advantage Dual SNP LIS Premium Summary Chart - Version en Español
|
2020/2019
Plan Benefits
|
FirstCare Advantage Select (HMO SNP)* |
| Monthly Payment |
2020 $0 - $20.80
2019 $0 - $23.90
(depending on your level of Low Income Subsidy) |
|
Inpatient Acute and Mental Health Hospital
|
$0/day
|
Skilled Nursing Facility (SNF)
No prior hospital stay required.
Covers up to 100 days per Medicare defined benefit period |
$0/day |
| Home Health |
$0 per visit |
|
Outpatient Surgery
(includes Outpatient Hospital & ASC locations)
|
$0 copay |
| Ambulance |
$0 copay |
| Emergency Care |
$0 copay |
| Urgent Care |
$0 copay |
Doctor Visits
Primary Care
Specialist |
$0 copay
$0 copay |
| Physical Therapy |
$0 copay |
| Speech Therapy |
$0 copay |
| Occupational Therapy |
$0 copay |
| Preventive Care |
$0 copay |
This information is not a complete description of benefits. Call 1-866-229-4969/TTY 7-1-1 for more information.
H5742_WEBSITE_2020_A | Last updated: 10/01/19.