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VIVA Medicare Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Premier (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Premier (HMO) in 2025, please refer to our full plan details page.
VIVA Medicare Premier (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 Premier (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about VIVA Medicare Premier (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 Premier (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $103.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $100.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6500.00 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
The VIVA Medicare Premier (HMO) plan has a $100 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay an $8 copay for a preferred generic drug at a standard pharmacy. For generic drugs, you can expect to pay a copay of $8-$47. For brand name drugs, you will pay 47% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The VIVA Medicare Premier (HMO) plan offers a range of benefits. Inpatient and outpatient hospital services, emergency services, and ambulance services are covered, with copays ranging from $0 to $275. Primary care, including specialist and mental health services, are covered with copays between $0 and $20, while preventive and home health services are covered with no copay. The plan also includes coverage for hearing and vision services, with hearing exams at no copay and eyewear benefits up to $200 annually. Dental services are covered with a $1,250 annual maximum. Additionally, the plan covers home infusion, dialysis, medical equipment, and skilled nursing facility services, each with their own cost structures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-6, and no copay for days 7-90; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has the same cost structure as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 $275, observation services have a $275 copay, and individual and group substance abuse sessions have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the VIVA Medicare Premier (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the VIVA Medicare Premier (HMO) plan. This includes ground and air ambulance services, each with a $275 copay and no coinsurance, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the VIVA Medicare Premier (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0-$40, and Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The VIVA Medicare Premier (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services with a $0-$20 copay, mental health specialty services with a $20 copay, other health care professional services with a $0-$20 copay, psychiatric services with a $20 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services with a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The VIVA Medicare Premier (HMO) plan covers preventive services including Medicare-covered preventive services, annual physical exams, fitness benefits, kidney disease education services, and other preventive services. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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 includes hearing exams with no copay, and prescription hearing aids with a copay between $500 and $1975 depending on the type of hearing aid. OTC hearing aids are also covered, with a copay between $750 and $2850.
Vision Services See details
Vision services are covered, including routine eye exams with a copay between $0 and $20. Eyewear benefits are also covered, with a combined maximum benefit of $200 every year.
Dental Services See details
The VIVA Medicare Premier (HMO) plan offers dental services with a $1,250 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the VIVA Medicare Premier (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 0-20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $100, and Therapeutic Radiological Services have a $30 copay, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Premier (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the VIVA Medicare Premier (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 by the VIVA Medicare Premier (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 45-100, but a $196 copay for days 21-44.
Other Services See details
The VIVA Medicare Premier (HMO) plan's Other Services benefit covers Over-the-Counter (OTC) Items, including nicotine replacement therapy, with a maximum benefit of $70 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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