A non-government entity
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 2025, 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 2025.
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 $40.00. 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 $577.00 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:
Sign up for VIVA Medicare Extra Value (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The VIVA Medicare Extra Value (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $577. After the deductible is met, you will pay coinsurance for your prescriptions. During the initial coverage phase, you will pay 25% coinsurance for most drugs at standard pharmacies, and 25% coinsurance at preferred and standard mail order pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The VIVA Medicare Extra Value (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. You can expect no copays for primary care, preventive services, and home health services, and a $0-$12 copay for vision exams. Copays apply to inpatient hospital stays, outpatient services, emergency services, specialist visits, and other services, with specific amounts depending on the service. This plan also covers hearing aids with copays, dental services up to $1050 per year, and offers additional benefits like transportation, OTC items, and home infusion. The plan does not cover certain services like cardiac rehabilitation, and has coinsurance for dialysis, medical equipment, and certain home infusion drugs.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered. For Inpatient Hospital-Acute, you will pay a $440 copay for days 1-6 and no copay for days 7-90, and for Additional Days for Inpatient Hospital-Acute, you will pay no copay for days 91-999. Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital-Psychiatric, you will pay a $440 copay for days 1-5 and no copay for days 6-90, and Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $400, observation services have a $400 copay, and individual and group sessions for outpatient substance abuse have a $12 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the VIVA Medicare Extra Value (HMO D-SNP) 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 by the VIVA Medicare Extra Value (HMO D-SNP) plan. Ground and Air Ambulance Services have a copay of $350.00, while Transportation Services to any health-related location are covered for up to 24 one-way trips per year, using modes such as taxi, rideshare, bus/subway, and medical transport.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency coverage. Emergency services have a $125 copay, urgently needed services have a copay between $0 and $40, and worldwide emergency coverage has a $125 copay, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
The VIVA Medicare Extra Value (HMO D-SNP) plan covers primary care physician services with no copay, physician specialist services with a copay between $0 and $12, and physical therapy and speech-language pathology services with a $12 copay and no coinsurance. Chiropractic services are partially covered, but routine chiropractic care is not covered. The plan also covers mental health and psychiatric services, additional telehealth benefits, and opioid treatment program services, each with a copay of $12 for individual or group sessions.
Preventive Services See details
Preventive services are covered, including an annual physical exam, additional preventive services, and kidney disease education services. Fitness benefits and remote access technologies are also covered, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, and prescription hearing aids with a copay between $300 and $1775, depending on the type. OTC hearing aids have a copay between $250 and $1350, and the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$12, and 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 Extra Value (HMO D-SNP) plan covers a variety of dental services, including oral exams, x-rays, and cleanings. This plan has a maximum benefit of $1050 per year, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the VIVA Medicare Extra Value (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the VIVA Medicare Extra Value (HMO D-SNP) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered by the VIVA Medicare Extra Value (HMO D-SNP) plan, with no copay. Durable Medical Equipment (DME) has a 25% coinsurance, while Prosthetic Devices have a 20% coinsurance. Medical Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $100 with a minimum copay of $10, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Extra Value (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the VIVA Medicare Extra Value (HMO D-SNP) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, the copay is $10, for days 21-55, the copay is $196, and there is no copay for days 56-100.
Other Services See details
The "VIVA Medicare Extra Value (HMO D-SNP)" plan covers Over-the-Counter (OTC) items with a maximum benefit of $50.00 every month, and includes Nicotine Replacement Therapy (NRT) and Naloxone coverage. Other services such as 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved