Medicare Advantage · HMO
Clear Spring Health
Plan year 2026

Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) H5454-006

Monthly premium
$0
+ your Part B premium
Max out-of-pocket
$6,751
in-network annual cap
Primary care
$0
per visit copay
Specialist
$25
per visit
This plan includes a Part B giveback, which lowers what you pay for your Medicare Part B premium by up to $2.1 a month. Depending on how you pay Part B, the reduction may appear in your Social Security payment or on your Part B bill. That is up to $25.2 a year. Processing can take time; confirm the amount and timing with the plan.
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.
Extra benefits for members who qualify
  • $60/month food and produce allowance
These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$300
Inpatient hospital
Days 1-5: $290/day, Days 6-90: $0/day
Inpatient mental health
Days 1-5: $290/day, Days 6-90: $0/day
Outpatient surgery
$225
Emergency room
$115
Urgent care
$40

What's included, and what it's actually worth6 benefits included. Tap any card for the detail

Part B giveback

$2.10/month
DetailsThis plan includes a Part B giveback, which lowers what you pay for your Medicare Part B premium by up to $2.10 a month.
Processing can take time; confirm the amount and timing with the plan.

OTC allowance

$50/month OTC allowance
Prepaid card$50/month OTC allowance

Hearing

$500/yr hearing aid allowance
Hearing aid allowance$500/yr hearing aid allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$250/yr eyewear allowance
Eyewear allowance$250/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$25 copay
In-network$25 copay per visit
Inpatient Hospital$290/day, days 1–5
In-networkDays 1-5: $290/day, Days 6-90: $0/day
Outpatient Surgery$225 copay
In-network$225 copay per procedure
Mental HealthDays 1-5: $290/day, Days 6-90: $0/day
Inpatient psychiatricDays 1-5: $290/day, Days 6-90: $0/day
Transportation12 one-way trips/year
Trips per year12 one-way trips/year
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
$0
Preferred Generic
Tier 2
$5
Generic
Tier 3
20%
Preferred Brand· after deductible
Tier 4
35%
Non-Pref Brand· after deductible
Tier 5
29%
Specialty· after deductible
Tier 6
$0
Tier 6· after deductible

Our take

Where this plan shines

This plan has a $0 monthly premium.
See your primary doctor for $0.
The specialist copay ($25) is among the more affordable options.

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)

What does Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) cover?

Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) is a Chronic Condition Special Needs Plan, a Medicare Advantage plan for people whose qualifying condition the plan verifies, including cardiovascular disorders and diabetes. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include vision ($250/yr eyewear allowance), hearing ($500/yr hearing aid allowance), over-the-counter (OTC) ($50/month OTC allowance), and transportation (12 one-way trips/year). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) cost in 2026?

The published 2026 monthly plan premium for Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) is $0. The standard Part B premium is $202.90/month in 2026 for most people; assistance may pay it for some members. The listed Part D deductible is $300. The in-network medical out-of-pocket maximum is $6,751; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $25. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)?

CMS lists Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) as a HMO plan. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

What chronic conditions qualify for Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)?

Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) is listed in the current plan record as a C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Learn about Special Needs Plans

How does Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) coordinate care for my chronic condition?

Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) is identified in the current plan record as a Chronic Condition Special Needs Plan for qualifying conditions that include Cardio DIS CHF and Diabetes. The record also lists vision ($250/yr eyewear allowance), hearing ($500/yr hearing aid allowance), and over-the-counter (OTC) ($50/month OTC allowance). The data on this page does not describe a personal care plan or promise a specific care coordinator. Review the Evidence of Coverage and ask the plan how its model of care, provider communication, and medication support apply to your verified condition.

When can I enroll in Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP)?

Clear Spring Health Balance+ Diabetes & Heart (HMO C-SNP) is a 2026 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a C-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Browse the full 2026 Chronic Condition Special Needs Plan directory. This plan is offered in Illinois. Plan availability can vary by county.

Helpful next steps

Clear Spring Health Balance+ Diabetes & Heart H5454-006 (HMO C-SNP) — 2026