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Astiva Health C-SNP Deluxe (HMO C-SNP) Medicare Special Need Plan H1993-007 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$2000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $0.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
6,300 beneficiaries
Last update:

Introduction

CMS Plan ID H1993-007 identifies Astiva Health C-SNP Deluxe, a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Astiva Health. Its provider network is a Health Maintenance Organization (HMO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $0.00 medical deductible, and $2000.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.

Enrollment across the plan's service areas totals 6,300 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.

Eligibility

Astiva Health C-SNP Deluxe is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health conditions.

Special Needs Plan Type
Chronic Condition Special Needs Plan (C-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Plan Benefits

Astiva Health C-SNP Deluxe has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1993-007.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $0 copay In-network: $0 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam Not covered Not covered
Telehealth benefit In-network: $0 copay In-network: $0 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$50 copay In-network: $0-$50 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $15 copay In-network: $0 copay
Diagnostic tests and procedures In-network: $0 copay In-network: $0 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $125 copay $75 copay
Worldwide emergency care Coming soon $0 copay
Urgent care $0 copay $0 copay
Inpatient hospital care Tier 1
$100 per day for days 1-5
$0 per day for days 6-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay		 Tier 1
$0 per day for days 1-5
$180 per day for days 6-15
$0 per day for days 16-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$221 per day for days 21-100		 Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Ground ambulance In-network: $50 copay In-network: $50 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $25 copay In-network: $25 copay
Outpatient group therapy In-network: $25 copay In-network: $25 copay
Inpatient psychiatric hospital care Tier 1
$100 per day for days 1-5
$0 per day for days 6-90
$0 Lifetime Reserve Days for days 1-60
$0 per stay		 Tier 1
$0 per day for days 1-5
$180 per day for days 6-15
$0 per day for days 16-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $10 copay In-network: $15 copay
Occupational therapy In-network: $10 copay In-network: $15 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Durable medical equipment In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Prosthetics In-network: 20% coinsurance In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: $0 copay In-network: $0 copay
Endodontics In-network: $0 copay In-network: $0 copay
Restorative services In-network: $0 copay In-network: $0 copay
Implant services In-network: $0 copay In-network: $0 copay
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay In-network: $0 copay

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay In-network: $0 copay
Contact lenses In-network: $0 copay In-network: $0 copay
Eyeglass frames only In-network: $0 copay In-network: $0 copay
Eyeglass lenses only In-network: $0 copay In-network: $0 copay
Eyeglasses (frames & lenses) In-network: $0 copay In-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $0 copay In-network: $0 copay
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon In-network: $0 copay
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies In-network: $0 copay In-network: $0 copay
Massage therapy In-network: $0 copay In-network: $0 copay
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Astiva Health C-SNP Deluxe as a Part B benefit.

Prescription Drug Coverage

Astiva Health C-SNP Deluxe 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.

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 Special Needs Plan coverage.

Astiva Health C-SNP Deluxe (H1993-007-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($65.20)
Supplemental Part D Premium:$65.20
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$7.28
Low-Income Premium Subsidy Paid by CMS:$0.00
Low-Income Subsidy Premium:$0.00

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Astiva Health starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Astiva Health C-SNP Deluxe may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Astiva Health C-SNP Deluxe (H1993-007-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay$0.00 copay
Preferred Brand$20.00 copay$20.00 copay
Non-Preferred Drug$45.00 copay$75.00 copay
Specialty Tier33% coinsurance33% coinsurance
Select Care Drugs$0.00 copay$0.00 copay
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H1993)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H1993
CMS Measure Star Rating
2027 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 Not enough data available
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Astiva Health

Website
Astiva Health Plan Page
Providers
Astiva Health Providers Page
Formulary
Astiva Health Formulary Page
Pharmacy
Astiva Health Pharmacy Page
New Member Health Plan Help
(866)610-0655
New Member Health Plan TTY
711
New Member Part D Help
(866)610-0655
New Member Part D TTY Users
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Astiva Health (official source) http://astivahealth.com October 4, 2026
CMS.gov Chronic Condition Special Needs Plans (C-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.