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VIVA Medicare Extra Value (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Extra Value (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Extra Value (HMO D-SNP) in 2026, please refer to our full plan details page.
VIVA Medicare Extra Value (HMO D-SNP) is a HMO D-SNP plan offered by Triton Health Systems, L.L.C. available for enrollment in 2025 to people living in Northwest, 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 Extra Value (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
VIVA Medicare Extra Value (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about VIVA Medicare Extra Value (HMO D-SNP).
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 Extra Value (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. 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 $615.00 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 $6750.00 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 Extra Value (HMO D-SNP) plan features a defined standard drug benefit with a yearly prescription drug deductible of $615.00. If you qualify for the Extra Help low-income subsidy, your Part D premium is reduced to $27.70. After meeting the deductible, you enter the initial coverage phase which lasts until total shared drug costs reach $2,100.00. Once your yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase where you have no copay and pay nothing for covered Part D drugs. However, you may still be responsible for a portion of the costs for any excluded drugs. Be sure to review the plan's formulary to confirm which specific medications are covered.
Additional Benefits
The VIVA Medicare Extra Value (HMO D-SNP) plan offers comprehensive medical coverage featuring low out-of-pocket costs, including no copay for preventive care, annual physicals, and home health services. For inpatient hospital stays, members pay a $440 daily copay for the first few days and no copay for the remainder of their stay, while primary care visits range from no copay up to an $18 copay. Outpatient services, diagnostics, and emergency care are covered primarily through flat copayments with no coinsurance, though dialysis and durable medical equipment require coinsurance of 20% and 25% respectively. This plan also provides valuable supplemental benefits, including a $1,050 annual dental allowance, a $150 eyewear allowance, and up to 24 one-way transportation trips to approved locations. Members also benefit from a $50 monthly allowance for over-the-counter items and affordable skilled nursing facility care, which features a low $10 daily copay for the first 20 days. Routine hearing and vision exams are highly accessible with costs ranging from no copay to an $18 copay.
Inpatient Hospital See details
VIVA Medicare Extra Value (HMO D-SNP) partially covers inpatient hospital benefits with no coinsurance, requiring a $440 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, with no copay for remaining covered days. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by VIVA Medicare Extra Value (HMO D-SNP), featuring copays ranging from no copay up to $400 for outpatient hospital services, a $400 copay per stay for observation services, and an $18 copay per session for substance abuse services. These benefits require no coinsurance and no deductible for blood services, although prior authorization is required for hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by VIVA Medicare Extra Value (HMO D-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by VIVA Medicare Extra Value (HMO D-SNP), which requires a $345 copay and no coinsurance for ground and air ambulance services. While the plan covers up to 24 one-way trips per year to plan-approved health-related locations, transportation to any health-related location is not covered.
Emergency Services See details
VIVA Medicare Extra Value (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay to a $40 copay and no coinsurance, while worldwide emergency services are partially covered up to $50,000, with worldwide urgent coverage and worldwide emergency transportation not covered.
Primary Care See details
Primary Care benefits are partially covered by VIVA Medicare Extra Value (HMO D-SNP), featuring copays that range from no copay up to $18 for most services, up to $40 for telehealth, and no coinsurance. While most primary and specialist services are included, podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by VIVA Medicare Extra Value (HMO D-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, and kidney disease education. Additional preventive benefits are only partially covered, including fitness benefits and remote access technologies, while sub-services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
VIVA Medicare Extra Value (HMO D-SNP) covers hearing exams with no deductible, no coinsurance, and a copay ranging from no copay to $18. Prescription hearing aids are partially covered with a $300 to $1,775 copay and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. Over-the-counter hearing aids are also covered with a $500 to $2,700 copay and no coinsurance.
Vision Services See details
VIVA Medicare Extra Value (HMO D-SNP) covers one routine eye exam per year with costs ranging from no copay to an $18 copay and no coinsurance. Additionally, the plan provides a $150 annual allowance for eyewear with no deductible, copay, or coinsurance.
Dental Services See details
Dental services are partially covered by VIVA Medicare Extra Value (HMO D-SNP), which provides up to $1,050 every year for diagnostic, preventive, and comprehensive dental care, though orthodontics is not covered. No copay or coinsurance details are specified in the plan benefits.
Home Infusion bundled Services See details
VIVA Medicare Extra Value (HMO D-SNP) covers Home Infusion bundled Services with prior authorization, featuring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the VIVA Medicare Extra Value (HMO D-SNP) plan with a 20% coinsurance and no copay. This benefit ensures access to vital dialysis treatments while maintaining clear and predictable cost-sharing for members.
Medical Equipment See details
Medical equipment is partially covered by VIVA Medicare Extra Value (HMO D-SNP) because diabetic supplies are not covered. Covered services require prior authorization and have no copay, featuring a 25% coinsurance for durable medical equipment, 20% coinsurance for prosthetic devices, no coinsurance to 20% coinsurance for medical supplies, and 10% coinsurance for diabetic therapeutic shoes and inserts.
Diagnostic and Radiological Services See details
VIVA Medicare Extra Value (HMO D-SNP) partially covers diagnostic and radiological services, with lab services not covered. Covered benefits require prior authorization and have no coinsurance, featuring copays ranging from no copay to $50 for diagnostic procedures, $10 to $100 for diagnostic radiology, $60 for therapeutic radiology, and $10 for outpatient X-rays.
Home Health Services See details
VIVA Medicare Extra Value (HMO D-SNP) covers home health services with no copay or coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the VIVA Medicare Extra Value (HMO D-SNP) plan. This lack of coverage applies to all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by VIVA Medicare Extra Value (HMO D-SNP) with a $10 copay for days 1-20, a $218 copay for days 21-51, no copay for days 52-100, and no coinsurance. The benefit is partially covered because prior authorization is required and additional days beyond Medicare-covered services are not covered.
Other Services See details
VIVA Medicare Extra Value (HMO D-SNP) partially covers Other Services, providing a $50 monthly allowance for over-the-counter (OTC) items and an Annual Wellness Visit Enhancement with no copay or coinsurance. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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