Senior Health Plan Platinum (HMO)
Medicare Advantage Plan H3755-001 • 2026
Senior Health Plan Platinum (HMO) Medicare Advantage Plan H3755-001 • 2026
This Medicare Advantage HMO plan, identified by CMS Plan ID H3755-001, is offered by CommunityCare Senior Health Plan (HMO) for the 2026 plan year. The plan uses a Health Maintenance Organization (HMO) provider network and comes with Part D prescription drug coverage.
Senior Health Plan Platinum Overview
Plan Overview for H3755-001-0 |
|
|---|---|
| CMS Plan ID: | H3755-001-0 |
| Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $24.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $4200.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $200.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide) | 21,596 beneficiaries |
| Provided By: | CommunityCare Senior Health Plan (HMO) |
Plan Availability
Senior Health Plan Platinum (H3755-001-0) is available in the following locations (click to open):
Coverage Overview for Senior Health Plan Platinum
This Medicare Advantage Prescription Drug (MAPD) HMO plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $24.00, and services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $200.00.
Primary care visits have a $0 copay, specialist visits come with a $30 copay, urgent care services carry a $30 copay, and ambulance transportation is $250 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $4200.00. After this limit is reached, in-network services are fully covered.
This plan is listed by CMS under Plan ID {title_plan_id}. A summary of cost sharing is provided below.
Out-of-Pocket Costs
Senior Health Plan Platinum includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H3755-001.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $30 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$30 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0-$100 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0-$100 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $120 copay |
| Worldwide emergency care: | $120 copay |
| Urgent care: | $30 copay |
| Inpatient hospital care: | Tier 1 | $270 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $140 per day for days 21-100 |
| Ground ambulance: | In-network: $250 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $20 copay |
| Outpatient group therapy: | In-network: $20 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $270 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20 copay |
| Occupational therapy: | In-network: $20 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 0%-15% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| 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: 50% coinsurance |
| Restorative services: | In-network: $0 copay |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| 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 |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | In-network: $0 copay |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Senior Health Plan Platinum as a Part B benefit.
Prescription Drug Coverage
Senior Health Plan Platinum includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Advantage coverage.
| Basic Part D Premium: | $24.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $24.00 |
| Low-Income Premium Subsidy: | $28.24 |
| Low-Income Premium Subsidy Paid by CMS: | $24.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $200.00 annual Part D deductible. You'll pay this deductible at the pharmacy before CommunityCare Senior Health Plan (HMO) starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Senior Health Plan Platinum may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Ratings
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Is there a monthly premium for this plan in 2026?
For 2026, the monthly premium is $24.00. Medicare Part B premiums apply in addition to this amount.
What is the in-network MOOP for plan H3755-001?
For 2026, the in-network maximum out-of-pocket is $4200.00. The plan pays 100% of covered in-network services beyond this amount.
What is the CMS star rating for this plan?
CMS rates this plan at ★3.5 out of 5 stars for 2026.
What is the total enrollment for plan H3755-001?
Total enrollment is 21,596 beneficiaries based on the latest CMS data.
Is there a Part D deductible for this plan?
The Part D deductible is $200.00.
Contact Information for CommunityCare Senior Health Plan (HMO)
| Contact Type | Details |
|---|---|
| Website: | CommunityCare Senior Health Plan (HMO) Plan Page |
| New Members: | 1-800-642-8065 |
| Existing Members: | 1-800-642-8065 |
| Plan Address: | Williams Center Tower II | Two West Second Street, Suite 100 | Tulsa, OK 74103 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- CommunityCare Senior Health Plan (HMO) (official source), http://www.ccokadvantage.com/2025/SHP — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.