CommuniCare Advantage
CommuniCare Advantage is a provider-owned Medicare Advantage HMO offering Institutional Special Needs Plans for nursing facility residents and Chronic Condition Special Needs Plans for individuals with diabetes, heart failure, or cardiovascular disease across select counties in Ohio, Maryland, and Indiana.
- Company typePrivate
- Founded-
- HeadquartersBlue Creek, United States
- Headcount11–50
- GTM typeB2C
- OfferingServices
What CommuniCare Advantage does
CommuniCare Advantage, operating through the legal entity OH CHS SNP, Inc., is a provider-owned Medicare Advantage HMO that specializes in CMS-defined Special Needs Plans. Its two core products are the ISNP (Institutional Special Needs Plan), which serves Medicare beneficiaries residing in contracted nursing facilities, and the CSNP (Chronic Condition Special Needs Plan), which serves community-dwelling beneficiaries diagnosed with diabetes mellitus, chronic heart failure, or cardiovascular disease. The legal and operational footprint spans select counties in Ohio, Maryland, and Indiana.
The operating model is built on CMS capitation revenue (Medicare premium payments, supplemented by member premiums) under a single HMO Medicare contract, with enrollment structurally gated by eligibility — nursing facility residency for ISNP and specific chronic conditions for CSNP. The technology surface includes a member self-service portal at myamethyst.com (benefits, provider search, pharmacy lookup) and a recently transitioned provider portal operated by Access Health Services for authorization, claims, and encounter workflows effective January 1, 2026. Clinical delivery for ISNP is anchored by Personalized Health Partners as the primary care coordination partner, while pharmacy benefit management is outsourced to MedImpact. A four-vendor supplemental benefits layer (FCL Dental, RideHealth, Nations Hearing, Nations Vision) wraps additional services around the core medical coverage.
Distribution is direct-to-consumer through toll-free phone enrollment, mail-in forms, and — most importantly — referrals from contracted nursing facility providers. Enrollment and member services are operated from a small team (11–50 employees) across mailing addresses in Little Rock, AR (enrollment) and Blue Ash and Cincinnati, OH (provider relations and premium payments), with Stephen Rosedale serving as President, CEO, and Founder. The operating structure is fully private, with no public funding, acquisition activity, or parent-company relationship disclosed in the available record.
CommuniCare Advantage firmographics
Firmographics- Name
- CommuniCare Advantage
- Legal name
- OH CHS SNP, Inc.
- Website
- https://communicare-advantage.com
- Company type
- Private
- Operating status
- Operating
- Headcount range
- 11–50 employees
- Short description
- CommuniCare Advantage is a provider-owned Medicare Advantage HMO offering Institutional Special Needs Plans for nursing facility residents and Chronic Condition Special Needs Plans for individuals with diabetes, heart failure, or cardiovascular disease across select counties in Ohio, Maryland, and Indiana.
- Ownership category
- akta.pro rank
CommuniCare Advantage industry classification
Industry- Product category
- Medicare Advantage Health Insurance
- NAICS
- Direct Health and Medical Insurance Carriers (524114)
- SIC
- Accident & Health Insurance (6321)
- akta.pro primary industry
- Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)
- akta.pro secondary industries
- MA HMO Plans (HLAEACAA), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), Medicare Advantage (MA) Plans (FSAIAGAA)
Keywords
Where CommuniCare Advantage is headquartered
LocationHeadquarters
- HQ city
- Blue Creek
- HQ country
- United States
- HQ region
- North America
Offices3 records
Markets served
CommuniCare Advantage business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure
Revenue model
- Medicare Advantage Premiums: CommuniCare Advantage operates as an HMO with Medicare contract to provide Medicare Advantage plans. Revenue is generated through Medicare payments and member premiums for ISNP and CSNP specialty plans covering nursing facility residents and individuals with chronic conditions.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | ISNP (Institutional Special Needs Plan) - Medicare Advantage specialty plan for nursing home residents |
| Subscription | Monthly | CSNP (Chronic Condition Special Needs Plan) - Medicare Advantage specialty plan for chronic condition management |
Go-to-market motion1 record
Distribution channels3 records
Marketing channels3 records
CommuniCare Advantage product offering
Product offeringCore offering
CommuniCare Advantage operates an HMO with a Medicare contract delivering two Medicare Advantage Special Needs Plans: an Institutional Special Needs Plan (ISNP) for residents in contracted long-term care nursing facilities and a Chronic Condition Special Needs Plan (CSNP) for community-dwelling Medicare beneficiaries with diabetes mellitus, chronic heart failure, or cardiovascular disease. The plans coordinate care through interdisciplinary teams, provide supplemental benefits (dental, vision, hearing, transportation, pharmacy), and are sold via direct enrollment plus provider and nursing facility referrals in Ohio, Maryland, and Indiana.
Product overview
CommuniCare Advantage is a provider-owned Medicare Advantage health plan offering two Special Needs Plans: the ISNP (Institutional Special Needs Plan) for nursing facility residents and the CSNP (Chronic Condition Special Needs Plan) for individuals with diabetes, chronic heart failure, or cardiovascular disease. The company operates as an HMO with Medicare contract approval, providing coordinated care through provider networks in select Ohio, Maryland, and Indiana counties.
Differentiator
Problem solved
Functional benefit
Brands
- ISNP (Institutional Special Needs Plan): Medicare Advantage specialty plan serving members living in participating nursing facilities with extra benefits outside of traditional Medicare.
- CSNP (Chronic Condition Special Needs Plan)
Products and services
- ISNP (Institutional Special Needs Plan) Medicare Advantage specialty plan serving Medicare-eligible residents in participating long-term care nursing facilities, providing coordinated care, case management, and supplemental benefits (dental, vision, hearing, transportation, and pharmacy) beyond traditional Medicare across selected Ohio, Maryland, and Indiana counties.
- CSNP (Chronic Condition Special Needs Plan) Medicare Advantage specialty plan serving Medicare-eligible community-dwelling individuals managing diabetes mellitus, chronic heart failure, or cardiovascular disease, with coordinated care, chronic condition management, and supplemental benefits (dental, vision, hearing, transportation, and pharmacy) in select Maryland and Ohio counties.
Companies that use CommuniCare Advantage
Customer profileNamed customers2 records
Segments2 records
Ideal customer profiles3 records
CommuniCare Advantage technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature4 records
CommuniCare Advantage partnerships and signals
Strategic signalPartnerships
Seven partnerships are on record, tiered core and minor.
- Access Health ServicescoreEffective January 1, 2026, Access Health Services began overseeing the CommuniCare Advantage provider portal. Providers can submit authorization requests, check authorization status, and view claims/encounter information through this portal.
- Personalized Health PartnerscorePrimary care partner for ISNP members providing proactive care coordination at nursing facilities. Leads care coordination at a cadence appropriate to member health needs as part of CommuniCare Advantage's Model of Care.
- FCL DentalminorSupplemental dental benefit provider for CommuniCare Advantage members. Dental coverage is part of the supplemental benefits offered through the Medicare Advantage plans.
- RideHealth TransportationminorTransportation benefit provider for CommuniCare Advantage members, enabling access to medical appointments and healthcare services as part of supplemental benefits.
- Nations HearingminorHearing benefit provider offering hearing aids and hearing care services to CommuniCare Advantage members as part of supplemental Medicare Advantage benefits.
- Nations VisionminorVision benefit provider for CommuniCare Advantage members including eye exams and eyewear coverage as supplemental plan benefits.
- MedImpactcorePharmacy claims processor for CommuniCare Advantage. Located at 10181 Scripps Gateway Ct., San Diego, CA 92131. Handles prescription drug coverage and pharmacy benefit management for ISNP and CSNP members.
Scale indicators1 record
Recent moves5 records
Expansion highlights4 records
CommuniCare Advantage competitors and assessment
Company assessmentBroad incumbents
- UnitedHealth Group / Optum: Largest US health insurer and Medicare Advantage carrier, with vertically integrated care delivery through Optum. Comparable as the dominant MA incumbent whose UnitedHealthcare SNP products compete directly with CommuniCare Advantage's ISNP and CSNP offerings in overlapping geographies.
- Centene Corporation: Large government-sponsored health insurer with Medicare Advantage and dual-eligible SNP products alongside its dominant Medicaid business. Comparable as a major MA payer serving complex Medicare populations with care-coordination and supplemental benefits.
- Molina Healthcare: Government-sponsored health plan focused on Medicaid and Medicare Advantage, including D-SNP and CSNP products. Comparable as a smaller-than-UNH/Humana payer with significant dual-eligible and chronic-condition focus, competing in overlapping states like Ohio.
- Humana: Largest US operator of Medicare Advantage Special Needs Plans, particularly ISNPs through its CenterWell skilled-nursing footprint. Highly comparable because it dominates the exact SNP niches (ISNP + CSNP) that CommuniCare Advantage targets, with similar supplemental benefits and care-coordination model.
- Elevance Health (Anthem): Major Blue Cross/Blue Shield-affiliated Medicare Advantage carrier with SNP offerings across multiple states. Comparable as a broad MA incumbent with CSNP and D-SNP products competing in Ohio and Indiana.
- CVS Health / Aetna: Vertically integrated payer-retailer with a sizeable Medicare Advantage book including SNPs. Comparable as a major MA carrier offering ISNP/CSNP products with supplemental benefits and pharmacy integration similar to CommuniCare Advantage's MedImpact partnership.
- Cigna Group: Diversified health services company offering Medicare Advantage plans including SNPs to seniors and dual-eligible beneficiaries. Comparable as a national MA competitor with supplemental benefits and care-coordination offerings.
Emerging players
- Clover Health: Technology-focused Medicare Advantage plan with a chronic-condition management orientation, serving dual-eligible and senior populations. Comparable as a smaller-scale, tech-enabled MA competitor pursuing similar complex-beneficiary populations.
- Bright Health Group: Tech-enabled Medicare Advantage carrier historically focused on dual-eligible and chronic-condition populations. Comparable as a smaller, technology-led MA plan serving similar complex Medicare beneficiary profiles, though it has narrowed its footprint in recent years.
Direct peers
- Alignment Health: Tech-forward Medicare Advantage plan with a strong focus on dual-eligible and chronic-condition populations across multiple states. Highly comparable as a smaller-scale, technology-led MA plan serving complex Medicare beneficiaries with supplemental benefits and care coordination.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights6 records
Customer concentration
CommuniCare Advantage social profiles
Digital presenceCommuniCare Advantage financial estimates
Financial estimateRevenue estimate
Valuation estimate
CommuniCare Advantage leadership team
Management profileNumber of profiles
Profiles1 record
CommuniCare Advantage funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
CommuniCare Advantage M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about CommuniCare Advantage
What does CommuniCare Advantage do?
CommuniCare Advantage operates an HMO with a Medicare contract delivering two Medicare Advantage Special Needs Plans: an Institutional Special Needs Plan (ISNP) for residents in contracted long-term care nursing facilities and a Chronic Condition Special Needs Plan (CSNP) for community-dwelling Medicare beneficiaries with diabetes mellitus, chronic heart failure, or cardiovascular disease. The plans coordinate care through interdisciplinary teams, provide supplemental benefits (dental, vision, hearing, transportation, pharmacy), and are sold via direct enrollment plus provider and nursing facility referrals in Ohio, Maryland, and Indiana.
Is CommuniCare Advantage a public or private company?
CommuniCare Advantage is a private company. It is classified as corporate owned and is currently operating.
When was CommuniCare Advantage founded?
CommuniCare Advantage was founded in -1. It employs 11 to 50 people.
Where is CommuniCare Advantage based?
CommuniCare Advantage is headquartered in Blue Creek, United States, in the North America region.
How does CommuniCare Advantage make money?
One revenue line is on record: medicare Advantage Premiums.
Who are CommuniCare Advantage's main competitors?
Broad incumbents on record are UnitedHealth Group / Optum, Centene Corporation, Molina Healthcare, Humana, Elevance Health (Anthem), CVS Health / Aetna and Cigna Group. Emerging players are Clover Health and Bright Health Group. Alignment Health is listed as a direct peer.
Does CommuniCare Advantage have an API?
No public API is recorded for CommuniCare Advantage.
What industry is CommuniCare Advantage in?
CommuniCare Advantage's product category is Medicare Advantage Health Insurance. Its primary akta.pro industry code is HLAEAMAH, Medicare Advantage HMOs (HMO/HMO-POS), with a secondary code of HLAEACAA, MA HMO Plans. Its NAICS code is 524114 and its SIC code is 6321.