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Texas Independence Community Plan (HMO I-SNP) H5015-002 • 2026 • Gonzales County, TX

CMS Rating: ☆☆☆☆☆ (5.0 out of 5 stars*)

CMS Plan ID H5015-002 identifies the Medicare Institutional plan Texas Independence Community Plan, offered by Texas Independence Health Plan for the 2026 plan year. This Special Needs Plan (SNP) is designed for individuals who meet specific eligibility requirements.

Last update:

Texas Independence Community Plan Overview

Medicare Special Needs Plan Overview (2026)
Plan Overview for H5015-002-0
CMS Plan ID: H5015-002-0
Plan Type: HMO I-SNP
Plan Year: 2026
Monthly Premium: $4.80
Plus your Medicare Part B premium.
Medical Deductible: $0.00
Maximum Out-of-Pocket: $9250.00 (In-Network)
Part B Give Back: Not offered
Prescription Drug Coverage: Basic, $615.00 deductible
Additional Benefits: Dental, Vision, Hearing
Service Area: Gonzales County, TX
Enrollment (Nationwide): 0 beneficiaries
Enrollment (CMS – Local)0 beneficiaries in Gonzales County
Provided By: Texas Independence Health Plan

Plan Overview and Eligibility

  1. Texas Independence Community Plan is an Institutional Special Needs Plan (I-SNP) for individuals living in an institution or requiring nursing-level care at home.
  2. This is an Institutional-Equivalent plan for individuals who need the level of care given in a facility who can remain at home, live in a group home setting, or an assisted living facility.
Eligibility requirements for Texas Independence Community Plan
Special Needs Plan Type: Institutional Special Needs Plan (I-SNP)
Medicare Requirement: Must have Medicare Part A and Part B
Special Needs Requirement: This is an Institutional-Equivalent plan for individuals who need the level of care given in a facility who can remain at home, live in a group home setting, or an assisted living facility.
Service Area Requirement: Must live in the plan's service area
Prescription Drug Coverage: Medicare Part D prescription drug coverage is included.

This plan uses a Health Maintenance Organization (HMO) network, meaning covered services are primarily provided by in-network doctors and facilities. Referrals are typically required for specialist care. Emergency services and out-of-area dialysis are covered outside the network.

Covered Services & Costs

This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.

In-network cost sharing for primary and specialist office visits.
Covered Service In-Network Cost
Primary: In-network: 20% coinsurance
Specialist: In-network: 20% coinsurance

This section outlines in-network costs for preventive and wellness services included in the plan.

In-network cost sharing for preventive and wellness services.
Covered Service In-Network Cost
Annual wellness exam: In-network: 20% coinsurance
Telehealth benefit: In-network: 20% coinsurance
Routine chiropractic: Not covered
Fitness benefits: Not covered
Health education: Not covered
Counseling services: Not covered
Over-the-counter drug benefits: In-network: $0 copay
Health transportation (non-emergency): Not covered

This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.

In-network cost sharing for diagnostic, lab, and imaging services.
Covered Service In-Network Cost
Diagnostic radiology services: In-network: 20% coinsurance
Lab services: In-network: 20% coinsurance
Outpatient x-rays: In-network: 20% coinsurance
Diagnostic tests and procedures: In-network: 20% coinsurance

This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.

In-network cost sharing for emergency, urgent care, and inpatient hospital services.
Covered Service In-Network Cost
Emergency room care: 20% coinsurance
Worldwide emergency care: Not covered
Urgent care: 20% coinsurance
Inpatient hospital care: Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 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: 20% coinsurance

This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.

In-network cost sharing for mental health services.
Covered Service In-Network Cost
Outpatient individual therapy: In-network: 20% coinsurance
Outpatient group therapy: In-network: 20% coinsurance
Inpatient psychiatric hospital care: Tier 1 | $0 per day for days 1-60 | $419 per day for days 61-90 | $838 per day for days 91-150

This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.

In-network cost sharing for rehabilitation services.
Covered Service In-Network Cost
Physical therapy and speech and language therapy: In-network: 20% coinsurance
Occupational therapy: In-network: 20% coinsurance

This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.

In-network cost sharing for medical equipment and supplies.
Covered Service In-Network Cost
Diabetes supplies: In-network: 20% coinsurance
Durable medical equipment: In-network: 20% coinsurance
Prosthetics: In-network: 20% coinsurance

This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.

In-network cost sharing for 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.

In-network cost sharing for dental services.
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: $0 copay
Restorative services: In-network: $0 copay
Implant services: In-network: $0 copay
Orthodontics: In-network: $0 copay
Oral/Maxillofacial surgery: In-network: $0 copay

This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.

In-network cost sharing for vision services and eyewear.
Covered Service In-Network Cost
Routine eye exam: In-network: $0 copay
Contact lenses: In-network: $0 copay
Eyeglass frames only: In-network: $0 copay
Eyeglass lenses only: In-network: $0 copay
Eyeglasses (frames & lenses): Not covered
Upgrades: Not covered

This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.

In-network cost sharing for hearing aids and related services.
Covered Service In-Network Cost
Hearing exam: In-network: $0 copay
Fitting/evaluation: In-network: $0 copay
Prescription hearing aids: Not covered
OTC hearing aids: Not covered

This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.

In-network cost sharing for additional and special needs services.
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 Texas Independence Community Plan as a Part B benefit.

Prescription Drug Coverage

Texas Independence Community Plan 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 Special Needs 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.

Texas Independence Community Plan Prescription Drug Plan Premium Details
Basic Part D Premium: $4.80
Supplemental Part D Premium: $0.00
Total Part D Premium: $4.80
Low-Income Premium Subsidy: $4.82
Low-Income Premium Subsidy Paid by CMS: $4.80
Low-Income Subsidy Premium: $0.00

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

Prescription Drug Plan Deductible

This plan has a $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Texas Independence Health Plan starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Texas Independence Community Plan may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Texas Independence Community Plan Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Brand-name drugs25% coinsuranceComing soon
Generic drugs25% coinsuranceComing soon
*Deductible does not apply.

CMS Star Ratings

CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.

2026 Medicare Star Ratings for Contract H5015
CMS Measure Star Rating
2026 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan Not enough data available
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 Not enough data available
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Texas Independence Health Plan

Texas Independence Health Plan Plan Contact Details for Texas Independence Community Plan (HMO I-SNP)
Contact Type Details
Website: Texas Independence Health Plan Plan Page
New Members: 1-833-471-8447
Existing Members: 1-833-471-8447
Plan Address: 1908 N. Laurent, Suite 250 | Victoria, TX 77901

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

Primary CMS datasets used for this Medicare Advantage Special Needs Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services September 8, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services September 8, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services September 8, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services September 8, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Texas Independence Health Plan (official source) http://www.txindependencehealthplan.com October 13, 2025
CMS.gov Institutional Special Needs Plans (I-SNPs) April 28, 2026
CMS.gov Medicare Advantage Plan Fact Sheet April 28, 2026
Medicare.gov Joining a plan April 28, 2026

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.