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VIVA Medicare Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Select (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Select (HMO) in 2026, please refer to our full plan details page.
VIVA Medicare Select (HMO) is a HMO plan offered by Triton Health Systems, L.L.C. available for enrollment in 2025 to people living in North, Central, and South Alabama. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that VIVA Medicare Select (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about VIVA Medicare Select (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For VIVA Medicare Select (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $65.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by VIVA Medicare Select (HMO).
Additional Benefits
The VIVA Medicare Select (HMO) plan offers robust medical coverage with predictable costs, featuring no copay for primary care visits and copays up to $40 for specialist visits. For inpatient hospital stays, members pay a $390 daily copay for the first six days, followed by no copay for additional days. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgent care services range from no copay to $40. This plan also includes key supplemental benefits, such as routine dental coverage up to $1,000 annually, a $150 eyewear allowance, and routine hearing exams with no copay. Additionally, members benefit from no copay for preventive services and a $40 quarterly allowance for over-the-counter items. Major medical needs like durable medical equipment, dialysis, and prosthetic devices are covered with a standard 20% coinsurance.
Inpatient Hospital See details
VIVA Medicare Select (HMO) covers inpatient acute hospital stays with a $390 daily copay for days 1 through 6 and no copay or coinsurance for days 7 through 999. Inpatient psychiatric care is also covered with a $390 daily copay for days 1 through 5 and no copay or coinsurance for days 6 through 90, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
VIVA Medicare Select (HMO) covers outpatient services with no coinsurance, though prior authorization is required for several benefits. Depending on the service, patients will pay no copay to $390 for outpatient hospital visits, $390 per stay for observation services, and a $35 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
VIVA Medicare Select (HMO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by VIVA Medicare Select (HMO), with ground and air ambulance services requiring a $330 copay and no coinsurance. Prior authorization is required for ambulance services, while transportation services to plan-approved and any health-related locations are not covered.
Emergency Services See details
VIVA Medicare Select (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a range of no copay to a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum limit with a $115 copay and no coinsurance for worldwide emergency coverage, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary care is partially covered by VIVA Medicare Select (HMO) with no coinsurance and copays ranging from no copay up to $40 for services like specialist visits, therapy, and telehealth. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
VIVA Medicare Select (HMO) covers preventive services, including annual physical exams, kidney disease education, and Medicare-covered zero-dollar preventive services with no copay. Additional preventive services are partially covered, offering fitness benefits and remote access technologies, while sub-services such as health education, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services are covered by VIVA Medicare Select (HMO) with no coinsurance, offering routine exams with no copay to a $35 copay and OTC hearing aids with a $750 to $2,850 copay. Prescription hearing aids are partially covered with a $500 to $1,975 copay, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
VIVA Medicare Select (HMO) covers annual routine eye exams with a copay ranging from no copay up to $35 and no coinsurance. The plan also features a $150 annual maximum benefit for eyewear, including contact lenses and eyeglasses, with no deductible or coinsurance.
Dental Services See details
VIVA Medicare Select (HMO) partially covers dental services with a maximum benefit of $1,000 every year, though orthodontics is not covered.
Home Infusion bundled Services See details
VIVA Medicare Select (HMO) covers home infusion bundled services with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin drugs. Other covered Part B chemotherapy, radiation, and clinical drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by VIVA Medicare Select (HMO) with 20% coinsurance and no copay.
Medical Equipment See details
VIVA Medicare Select (HMO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered services like durable medical equipment, prosthetic devices, and diabetic shoes require a 20% coinsurance, while medical supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
VIVA Medicare Select (HMO) diagnostic and radiological services are partially covered, requiring prior authorization, though lab services are not covered. Covered diagnostic procedures range from no copay to $50, outpatient x-rays have a $10 copay, therapeutic radiology costs $60, and diagnostic radiology ranges from $10 to $150, all with no coinsurance.
Home Health Services See details
Home Health Services are covered under VIVA Medicare Select (HMO) with prior authorization required. Specific copay and coinsurance details are not provided for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under VIVA Medicare Select (HMO) because none of the individual sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by VIVA Medicare Select (HMO), as additional days beyond the Medicare-covered limit are not covered. This benefit requires prior authorization and features no coinsurance, with no copay for days 1 to 20, a $218 daily copay for days 21 to 63, and no copay for days 64 to 100.
Other Services See details
VIVA Medicare Select (HMO) partially covers Other Services, offering a $40 quarterly allowance for over-the-counter items with no copay or coinsurance, as well as an Annual Wellness Visit Enhancement. Acupuncture, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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