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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 2025, 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 2025.
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 $9350.00 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 a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have copays depending on the service. Emergency services have a $110 copay, and ambulance services have a $350 copay. This plan also includes coverage for primary care, hearing, vision, and dental services. Hearing exams are available with no copay, and dental services such as oral exams and cleanings have no copay. The plan covers home health services, and medical equipment, but with some coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $390 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $390 for days 1-5, and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $390, while observation services have a $390 copay. Individual and group outpatient substance abuse sessions have a copay of $35.
Partial Hospitalization See details
Partial Hospitalization benefits are covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the VIVA Medicare Select (HMO) plan. Ground and air ambulance services have a $350 copay with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the VIVA Medicare Select (HMO) plan, with a $110 copay for emergency and worldwide emergency coverage. Urgently needed services have a copay between $0 and $40. Worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
The VIVA Medicare Select (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $35 copay, physician specialist services with a copay between $0 and $35, and mental health specialty services with a $35 copay. This plan also covers other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Additional preventive services do not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with copays between $500 and $1975, but inner ear, outer ear, and over the ear hearing aids are not covered; OTC hearing aids have a copay between $750 and $2850.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, as well as coverage for eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
The VIVA Medicare Select (HMO) plan covers a range of dental services, including oral exams, dental x-rays, and other diagnostic services with no copay. The plan also includes coverage for cleanings, fluoride treatments, and other preventative services with no copay, and a yearly maximum of $1,000. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the VIVA Medicare Select (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the VIVA Medicare Select (HMO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the VIVA Medicare Select (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, Diagnostic Radiological Services have a copay of at most $150 with a minimum copay of $10, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $10 copay; however, Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Select (HMO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the VIVA Medicare Select (HMO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20 and 64-100, there is no copay, while days 21-63 have a $214 copay.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum benefit of $40 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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