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
2021 FirstCare Advantage Dual SNP LIS Premium Summary Chart
2021 First Care Advantage Dual SNP LIS Premium Summary Chart - Version en Español
|
2021 Plan Benefits
|
FirstCare Advantage Premier
(HMO SNP)*
|
FirstCare Advantage Select
(HMO SNP)* |
| Monthly Payment |
$0 - $22.50
(depending on your level
of Low Income Subsidy) |
$0 - $22.50
(depending on your level
of Low Income Subsidy) |
|
Inpatient Hospital
|
$0/day |
Medicare-defined
cost sharing |
Skilled Nursing Facility (SNF)
No prior hospital stay required.
Covers up to 100 days per Medicare defined benefit period |
$0/day |
Days 1-20: $0
Days 21-100: $176 |
| Home Health |
$0/day |
Days 1-20: $0
Days 21-100: $176 |
|
Outpatient Surgery
(includes Outpatient Hospital & ASC locations)
|
$0 copay |
Medicare-defined
cost sharing |
| Ambulance |
$0 copay |
20% coinsurance |
| Emergency Care |
$0 copay |
20% up to $90 |
| Urgent Care |
$0 copay |
20% up to $65 |
Doctor Visits
Primary Care
Specialist |
$0 copay
$0 copay |
$0 copay
20% coinsurance |
| Physical Therapy |
$0 copay |
20% coinsurance |
| Speech Therapy |
$0 copay |
20% coinsurance |
| Occupational Therapy |
$0 copay |
20% coinsurance |
| Preventive Care |
$0 copay |
$0 copay |
This information is not a complete description of benefits. Call 1-866-229-4969/TTY 711 for more information.
H5742_WEBSITE2021_A | Last updated: 10/01/20.