C-SNP | Annual Notice of Change

• This material is available for free in English, Spanish, Arabic, Vietnamese, Chinese, Tagalog, Farsi, and Russian.

  Notice of Availability of Language Assistance Services and Auxiliary Aids and Services

ATTENTION: If you need help in your language, call 1-800-232-3133, TTY users should call 1-855-266-4584. Aids and services for people with disabilities, like documents in braille and large print, are also available. Call 1-800-232-3133, TTY users should call 1-855-266-4584. These services are free of charge.

العربية (Arabic)
انتباه: إذا كنت بحاجة إلى مساعدة بلغتك، فاتصل على 1-800-232-3133 (TTY: 1-855-266-4584). كما تتوفر مساعدات وخدمات للأشخاص ذوي الإعاقة، مثل مستندات بطريقة برايل وبالخط الكبير. اتصل على 1-800-232-3133 (TTY: 1-855-266-4584). هذه الخدمات مجانية.

繁體中文 (Traditional Chinese)
請注意：如果您需要以您的語言提供幫助，請致電 1-800-232-3133 (TTY: 1-855-266-4584)。我們也提供給殘障人士的協助和服務，例如點字和大字體文件。請致電 1-800-232-3133 (TTY: 1-855-266-4584)。這些服務免費提供。

Español (Spanish)
ATENCIÓN: Si necesita ayuda en su idioma, llame al 1-800-232-3133 (TTY: 1-855-266-4584). También hay ayudas y servicios para personas con discapacidades, como documentos en braille y en letra grande. Llame al 1-800-232-3133 (TTY: 1-855-266-4584). Estos servicios son gratuitos.

فارسی (Farsi)
توجه: اگر به کمک به زبان خود نیاز دارید، با 1-800-232-3133 (TTY: 1-855-266-4584) تماس بگیرید. کمک‌ها و خدماتی برای افراد دارای معلولیت، مانند اسناد بریل و چاپ درشت نیز در دسترس است. با 1-800-232-3133 (TTY: 1-855-266-4584) تماس بگیرید. این خدمات رایگان هستند.

한국어 (Korean)
주의: 귀하의 언어로 도움이 필요하신 경우 1-800-232-3133 (TTY: 1-855-266-4584)번으로 전화하십시오. 점자 및 큰 활자 문서와 같은 장애인을 위한 지원 및 서비스도 제공됩니다. 1-800-232-3133 (TTY: 1-855-266-4584)번으로 전화하십시오. 이 서비스는 무료입니다.

Русский (Russian)
ВНИМАНИЕ! Если вам нужна помощь на вашем языке, звоните по номеру 1-800-232-3133 (TTY: 1-855-266-4584). Также предоставляются вспомогательные средства и услуги для людей с ограниченными возможностями, например, документы шрифтом Брайля и крупным шрифтом. Звоните по номеру 1-800-232-3133 (TTY: 1-855-266-4584). Эти услуги предоставляются бесплатно.

Tiếng Việt (Vietnamese)
CHÚ Ý: Nếu quý vị cần trợ giúp bằng ngôn ngữ của mình, vui lòng gọi số 1-800-232-3133 (TTY: 1-855-266-4584). Chúng tôi cũng hỗ trợ và cung cấp các dịch vụ cho người khuyết tật, như tài liệu chữ nổi Braille và bản in chữ lớn. Vui lòng gọi số 1-800-232-3133 (TTY: 1-855-266-4584). Các dịch vụ này đều miễn phí.

Tagalog (Filipino)
PAUNAWA: Kung kailangan mo ng tulong sa iyong wika, tumawag sa 1-800-232-3133 (TTY: 1-855-266-4584). Mayroon ding mga tulong at serbisyo para sa mga taong may kapansanan, tulad ng mga dokumentong nakasulat sa braille at malalaking titik. Tumawag sa 1-800-232-3133 (TTY: 1-855-266-4584). Libre ang mga serbisyong ito.

Հայերեն (Armenian)
ՈՒՇԱԴՐՈՒԹՅՈՒՆ: Եթե Ձեզ օգնություն է հարկավոր Ձեր լեզվով, զանգահարեք 1-800-232-3133 (TTY: 1-855-266-4584): Կան նաև օժանդակ միջոցներ ու ծառայություններ հաշմանդամություն ունեցող անձանց համար, օրինակ՝ Բրայլի գրատիպով ու խոշորատառ տպագրված նյութեր։ Զանգահարեք 1-800-232-3133 (TTY: 1-855-266-4584): Այդ ծառայություններն անվճար են։

ខ្មែរ (Cambodian)
ចំណាំ៖ បើអ្នកត្រូវការជំនួយជាភាសារបស់អ្នក សូមទូរស័ព្ទទៅ 1-800-232-3133 (TTY: 1-855-266-4584)។ មានជំនួយ និងសេវាសម្រាប់ជនពិការផងដែរ ដូចជាឯកសារជាអក្សរប្រាយ និងអក្សរធំៗ។ សូមទូរស័ព្ទទៅ 1-800-232-3133 (TTY: 1-855-266-4584)។ សេវាទាំងនេះមានឱ្យដោយឥតគិតថ្លៃ។

हिन्दी (Hindi)
ध्यान दें: अगर आपको अपनी भाषा में सहायता की आवश्यकता है तो 1-800-232-3133 (TTY: 1-855-266-4584) पर कॉल करें। अशक्तता वाले लोगों के लिए ब्रेल और बड़े अक्षरों में दस्तावेज़ जैसी सेवाएं भी उपलब्ध हैं। कृपया 1-800-232-3133 (TTY: 1-855-266-4584) पर कॉल करें। ये सेवाएं नि:शुल्क हैं।

Hmoob (Hmong)
CEEB TOOM: Yog koj xav tau kev pab txhais koj hom lus, hu rau 1-800-232-3133 (TTY: 1-855-266-4584). Muaj cov kev pab thiab kev pab cuam rau cov neeg xiam oob khab, xws li ntawv luam ua ntawv loj thiab ntawv Braille. Hu rau 1-800-232-3133 (TTY: 1-855-266-4584). Cov kev pab cuam no yog dawb.

日本語 (Japanese)
注意: 日本語での支援が必要な場合は、1-800-232-3133 (TTY: 1-855-266-4584) にお電話ください。 点字や大きな文字で書かれた書類など、障害をお持ちの方のための支援やサービスも提供しています。 1-800-232-3133 (TTY: 1-855-266-4584) にお電話ください。これらのサービスは無料です。

ພາສາລາວ (Laotian)
ປະກາດ: ຖ້າທ່ານຕ້ອງການຄວາມຊ່ວຍເຫຼືອໃນພາສາຂອງທ່ານ, ໃຫ້ໂທຫາ 1-800-232-3133 (TTY: 1-855-266-4584). ຍັງມີການຊ່ວຍເຫຼືອແລະການບໍລິການສໍາລັບຜູ້ພິການ, ເຊັ່ນເອກະສານທີ່ພິມໂດຍອັກສອນບາຣ໌ລ ແລະພິມໂຕໃຫຍ່. ໂທ 1-800-232-3133 (TTY: 1-855-266-4584). ການບໍລິການເຫຼົ່ານີ້ໃຫ້ຟຣີ.

Mien
LONGC HNYOUV JANGX LONGX OC: Beiv taux meih qiemx longc mienh tengx faan benx meih nyei waac nor douc waac daaih lorx taux 1-800-232-3133 (TTY: 1-855-266-4584). Liouh lorx jauv-louc tengx aengx caux nzie gong bun taux ninh mbuo wuaaic fangx mienh, beiv taux longc benx nzangc-pokc bun hluo mbiutc aengx caux aamz mborqv benx domh sou se mbenc nzoih bun longc. Douc waac daaih lorx 1-800-232-3133 (TTY: 1-855-266-4584). Naaiv deix nzie weih gong-bou jauv-louc se benx wang-henh tengx mv zuqc cuotv nyaanh oc.

ਪੰਜਾਬੀ (Punjabi)
ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਹਾਨੂੰ ਆਪਣੀ ਭਾਸ਼ਾ ਵਿੱਚ ਮਦਦ ਦੀ ਲੋੜ ਹੈ, ਤਾਂ 1-800-232-3133 (TTY: 1-855-266-4584) 'ਤੇ ਕਾਲ ਕਰੋ। ਅਸੀਂ ਉਪਲਬਧ ਕਰਵਾਉਂਦੇ ਹਾਂ ਸਹਾਇਤਾ ਅਤੇ ਸੇਵਾਵਾਂ ਜੋ ਕਿ ਅਪਾਹਜ ਵਿਅਕਤੀਆਂ ਲਈ ਹਨ, ਜਿਵੇਂ ਕਿ ਬ੍ਰੇਲ ਅਤੇ ਵੱਡੇ ਅੱਖਰਾਂ ਵਾਲੇ ਦਸਤਾਵੇਜ਼। ਕਿਰਪਾ ਕਰਕੇ 1-800-232-3133 (TTY: 1-855-266-4584) 'ਤੇ ਕਾਲ ਕਰੋ। ਇਹ ਸੇਵਾਵਾਂ ਮੁਫ਼ਤ ਹਨ।

ภาษาไทย (Thai)
โปรดทราบ: หากคุณต้องการความช่วยเหลือเป็นภาษาของคุณ กรุณาโทร 1-800-232-3133 (TTY: 1-855-266-4584). มีบริการช่วยเหลือและบริการสำหรับผู้พิการ เช่น เอกสารอักษรเบรลล์และตัวพิมพ์ขนาดใหญ่ กรุณาโทร 1-800-232-3133 (TTY: 1-855-266-4584). บริการเหล่านี้ฟรี

Українська (Ukrainian)
УВАГА! Якщо вам потрібна допомога вашою мовою, зателефонуйте за номером 1-800-232-3133 (TTY: 1-855-266-4584). Також надаються допоміжні засоби та послуги для людей з інвалідністю, наприклад документи шрифтом Брайля або великим шрифтом. Зателефонуйте за номером 1-800-232-3133 (TTY: 1-855-266-4584). Ці послуги є безкоштовними.

• Call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) for more information. Hours are 24 hours a day, 7 days a week. This call is free.

• This document may be available in other formats such as braille, large print or other alternative formats.

About Community y Más

• Community y Más (C-SNP) is an HMO C-SNP health plan with a Medicare contract. Enrollment in Community y Más depends on contract renewal.

• When this material says “we,” “us,” or “our,” it means Community Health Group. When it says “plan” or “our plan,” it means Community y Más.

• If you do nothing by December 7, 2026, you’ll automatically be enrolled in Community y Más. Starting January 1, 2027, you’ll get your medical and drug coverage through Community y Más. Go to Section 3 for more information about how to change plans and deadlines for making a change.

H6248_ANOC2027_C

These are 2026 cost-sharing amounts and can change for 2027. Community y Más will provide updated rates as soon as they’re released.

Factors that could change your Part D Premium Amount

• Late Enrollment Penalty - Your monthly plan premium will be more if you’re required to pay a lifetime Part D late enrollment penalty for going without Part D or other drug coverage that’s at least as good as Medicare drug coverage (also referred to as creditable coverage) for 63 days or more.

• Higher Income Surcharge - If you have a higher income, you may have to pay an additional amount each month directly to the government for Medicare drug coverage.

Medicare requires all health plans to limit how much you pay out of pocket for the year. This limit is called the maximum out-of-pocket amount. Once you’ve paid this amount, you generally pay nothing for covered Part A and Part B services (and other health services not covered by Medicare) for the rest of the calendar year.

Our network of providers has changed for next year. Review the 2027 Provider and Pharmacy Directory www.chgsd.com to see if your providers (primary care provider, specialists, hospitals, etc.) are in our network. Here’s how to get an updated Provider and Pharmacy Directory:

• Visit our website at www.chgsd.com.

• Call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) to get current provider information or to ask us to mail you a Provider and Pharmacy Directory.

We can make changes to the hospitals, doctors, and specialists (providers) that are part of our plan during the year. If a mid-year change in our providers affects you, call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) for help. You may have a special enrollment period if your provider leaves the plan network. For more information on your rights when a network provider leaves our plan, go to Chapter 3, Section 2.3 of your Evidence of Coverage.

Amounts you pay for your prescription drugs can depend on which pharmacy you use. Medicare drug plans have a network of pharmacies. In most cases, your prescriptions are covered only if they are filled at one of our network pharmacies.

Our network of pharmacies has changed for next year. Review the 2027 Provider and Pharmacy Directory at www.chgsd.com to see which pharmacies are in our network. Here’s how to get an updated Pharmacy Directory:

• Visit our website at www.chgsd.com.

• Call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) to get current pharmacy information or to ask us to mail you a Provider and Pharmacy Directory.

We can make changes to the pharmacies that are part of our plan during the year. If a mid-year change in our pharmacies affects you, call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) for help.

These are 2026 cost-sharing amounts and can change for 2027. Community y Más will provide updated rates as soon as they’re released.

Changes to Our Drug List

Our list of covered drugs is called a formulary or Drug List. A copy of our Drug List is provided electronically.

We made changes to our Drug List, which could include removing or adding drugs, changing the restrictions that apply to our coverage for certain drugs, or moving them to a different cost-sharing tier. Review the Drug List to make sure your drugs will be covered next year and to see if there will be any restrictions, or if your drug has been moved to a different cost-sharing tier.

Most of the changes in the Drug List are new for the beginning of each year. However, we might make other changes that are allowed by Medicare rules that will affect you during the calendar year. We update our online Drug List at least monthly to provide the most up-to-date list of drugs. If we make a change that will affect your access to a drug you’re taking, we’ll send you a notice about the change.

If you’re affected by a change in drug coverage at the beginning of the year or during the year, review Chapter 9 of your Evidence of Coverage and talk to your prescriber to find out your options, such as asking for a temporary supply, applying for an exception, and/or working to find a new drug. Call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) for more information.

Starting in 2027, we can immediately remove brand name drugs or original biological products on our Drug List if we replace them with new generics or certain biosimilar versions of the brand name drug or original biological product on the same or lower cost-sharing tier and with the same or fewer restrictions. Also, when adding a new version, we can decide to keep the brand name drug or original biological product on our Drug List but immediately move it to a different cost-sharing tier or add new restrictions or both.

For example: If you take a brand name drug or biological product that’s being replaced by a generic or biosimilar version, you may not get notice of the change 30 days in advance, or before you get a month’s supply of the brand name drug or biological product. You might get information on the specific change after the change is already made.

Some of these drug types may be new to you. For definitions of drug types, go to Chapter 12 of your Evidence of Coverage. The Food and Drug Administration (FDA) also provides consumer information on drugs. Go to the FDA website: FDA.gov/drugs/biosimilars/multimedia-education-materials-biosimilars#For%20Patients. You can also call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) or ask your health care provider, prescriber, or pharmacist for more information.

Do you get Extra Help to pay for your drug coverage costs?

If you’re in a program that helps pay for your drugs (Extra Help), the information about costs for Part D drugs may not apply to you. We sent you a separate material, called the Evidence of Coverage Rider for People Who Get Extra Help Paying for Prescription Drugs, which tells you about your drug costs. If you get Extra Help and you don’t get this material by October 2026, call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) and ask for the LIS Rider.

Drug Payment Stages

There are 3 drug payment stages: the Yearly Deductible Stage, the Initial Coverage Stage, and the Catastrophic Coverage Stage.

• Stage 1: Yearly Deductible

You start in this payment stage each calendar year. During this stage, you pay the full cost of your Tier 3, Tier 4 and Tier 5 drugs until you’ve reached the yearly deductible.

• Stage 2: Initial Coverage

Once you pay the yearly deductible, you move to the Initial Coverage Stage. In this stage, our plan pays its share of the cost of your drugs, and you pay your share of the cost. You generally stay in this stage until your year-to-date total drug costs reach $2,400.

• Stage 3: Catastrophic Coverage

This is the third and final drug payment stage. In this stage, you pay nothing for your covered Part D drugs. You generally stay in this stage for the rest of the calendar year.

Drug Costs in Stage 1: Yearly Deductible

The table shows your cost per prescription during this stage.

Drug Costs in Stage 2: Initial Coverage

We changed the tier for some of the drugs on our Drug List. To see if your drugs will be in a different tier, look them up on the Drug List. Most adult Part D vaccines are covered at no cost to you. For more information about the costs of vaccines, or information about the costs for a long-term supply or for mail-order prescriptions, go to Chapter 6 of your Evidence of Coverage.

Once you’ve paid $2,400 out of pocket for covered Part D drugs, you’ll move to the next stage (the Catastrophic Coverage Stage).

To stay in Community y Más, you don’t need to do anything. Unless you sign up for a different type of Medicare health plan or change to Original Medicare by December 7, you’ll automatically be enrolled in our Community y Más.

If you want to change plans for 2027, follow these steps:

• To change to a different Medicare health plan, enroll in the new plan. You’ll be automatically disenrolled from Community y Más. Remember, not all Medicare health plans cover prescription drugs. Also, be aware that for many plans, you can’t join a Medicare health plan and simultaneously purchase a prescription drug plan.

• To change to Original Medicare with Medicare separate drug coverage, you can enroll in a Part D plan, and you’ll automatically be disenrolled from Community y Más.

• To change to Original Medicare without a drug plan, you can send us a written request to disenroll. Call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) for more information on how to do this. Or call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask to be disenrolled. TTY users can call 1-877-486-2048. If you don’t enroll in a Medicare drug plan, you may pay a Part D late enrollment penalty (go to Section 5).

• To learn more about Original Medicare and the different types of Medicare plans, visit Medicare.gov, check the Medicare & You 2027 handbook, call your State Health Insurance Assistance Program (go to Section 5), or call 1-800-MEDICARE (1-800-633-4227).

People with Medicare can make changes to their coverage from October 15 – December 7 each year.

If you enrolled in a Medicare Advantage plan for January 1, 2027, and don’t like your plan choice, you can switch to another Medicare health plan (with or without Medicare drug coverage) or switch to Original Medicare (with or without separate Medicare drug coverage) between January 1 – March 31, 2027.

In certain situations, people may have other chances to change their coverage during the year. Examples include people who:

• Have Medicaid

• Get Extra Help paying for their drugs

• Have or are leaving employer coverage

• Move out of our plan’s service area

If you recently moved into, or currently live in, an institution (like a skilled nursing facility or long-term care hospital), you can change your Medicare coverage at any time. You can change to any other Medicare health plan (with or without Medicare drug coverage) or switch to Original Medicare (with or without separate Medicare drug coverage) at any time. If you recently moved out of an institution, you have an opportunity to switch plans or switch to Original Medicare for 2 full months after the month you move out.

You may qualify for help paying for prescription drugs. Different kinds of help are available:

• Extra Help from Medicare. People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay up to 75% or more of your drug costs including monthly drug plan premiums, yearly deductibles, and coinsurance. Also, people who qualify won’t have a late enrollment penalty. To see if you qualify, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048, 24 hours a day, 7 days a week.

  • Social Security at 1-800-772-1213 between 8 a.m. and 7 p.m., Monday – Friday for a representative. Automated messages are available 24 hours a day. TTY users can call 1-800-325-0778.

  • Your State Medicaid Office.

• Help from your state’s pharmaceutical assistance program (SPAP). California has a program called Prescription Drug Discount Program for Medicare Recipients that helps people pay for prescription drugs based on their financial need, age, or medical condition. To learn more about the program, check with your State Health Insurance Assistance Program (SHIP). To get the phone number for your state, visit shiphelp.org, or call 1-800-MEDICARE.

• Prescription Cost-sharing Assistance for Persons with HIV/AIDS. The AIDS Drug Assistance Program (ADAP) helps ensure that ADAP-eligible people living with HIV/AIDS have access to life-saving HIV medications. To be eligible for the ADAP operating in your state, you must meet certain criteria, including proof of state residence and HIV status, low income as defined by the state, and uninsured/under-insured status. Medicare Part D drugs that are also covered by ADAP qualify for prescription cost-sharing help through the AIDS Drug Assistance Program (ADAP). For information on eligibility criteria, covered drugs, how to enroll in the program, or, if you’re currently enrolled, how to continue getting help, call 1-844-421-7050. Be sure, when calling, to inform them of your Medicare Part D plan name or policy number.

• The Medicare Prescription Payment Plan. The Medicare Prescription Payment Plan is a payment option that works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by our plan by spreading them across the calendar year (January – December). Anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage plan with drug coverage) can use this payment option. If you’re participating in the Medicare Prescription Payment Plan and stay in the same Part D plan, your participation will be automatically renewed for 2027 you do not need to submit a new election request to continue participating in 2027. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.

Extra Help from Medicare and help from your SPAP and ADAP, for those who qualify, is more advantageous than participation in the Medicare Prescription Payment Plan. To learn more about this payment option, call us at 1-800-232-3133 (TTY users call 1-855-266-4584) or visit Medicare.gov.

• Call Member Services at 1-800-232-3133. (TTY users call 1-855-266-4584)

We’re available for phone calls 24 hours a day, 7 days a week. Calls to these numbers are free.

• Read your 2027 Evidence of Coverage

This Annual Notice of Change gives you a summary of changes in your benefits and costs for 2027. For details, go to the 2027 Evidence of Coverage for Community y Más. The Evidence of Coverage is the legal, detailed description of our plan benefits. It explains your rights and the rules you need to follow to get covered services and prescription drugs. Get the Evidence of Coverage on our website at www.chgsd.com or call Member Services at 1-800-232-3133 (TTY users call 1-855-266-4584) to ask us to mail you a copy.

• Visit www.chgsd.com

Our website has the most up-to-date information about our provider network (Provider Directory/Pharmacy Directory) and our List of Covered Drugs (formulary/Drug List).

The State Health Insurance Assistance Program (SHIP) is an independent government program with trained counselors in every state. In California, the SHIP is called California Health Insurance Counseling and Advocacy Program (HICAP).

Call California Health Insurance Counseling and Advocacy Program (HICAP) to get free personalized health insurance counseling. They can help you understand your Medicare plan choices and answer questions about switching plans. Call California Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222. Learn more about California Health Insurance Counseling and Advocacy Program (HICAP) by visiting www.shiphelp.org/about-medicare/regional-ship-location/california.

• Call 1-800-MEDICARE (1-800-633-4227)

  You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.

• Chat live with Medicare.gov

  You can chat live at Medicare.gov/talk-to-someone.

• Write to Medicare

  You can write to Medicare at PO Box 1270, Lawrence, KS 66044

• Visit Medicare.gov

  The official Medicare website has information about cost, coverage, and quality Star Ratings to help you compare Medicare health plans in your area.

• Read Medicare & You 2027

  The Medicare & You 2027 handbook is mailed to people with Medicare every fall. It has a summary of Medicare benefits, rights and protections, and answers to the most frequently asked questions about Medicare. Get a copy at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.