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VIVA Medicare Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Plus (HMO) in 2025, please refer to our full plan details page.
VIVA Medicare Plus (HMO) is a HMO plan offered by Triton Health Systems, L.L.C. available for enrollment in 2025 to people living in North, East, 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 Plus (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 Plus (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 Plus (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 $20.00. 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.
This plan has a $300.00 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 $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
The VIVA Medicare Plus (HMO) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you may pay a $12 copay for preferred generic drugs at a standard pharmacy or 42% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The VIVA Medicare Plus (HMO) plan offers coverage for a wide range of services. Inpatient hospital stays have a copay, while outpatient services have copays that vary. The plan also covers ambulance services, emergency services, and primary care visits with varying copays. Additional benefits include preventive services with no copay, hearing and vision services with copays, and dental services with a $900 annual maximum. The plan also covers home health services with no copay, skilled nursing facility stays with copays, and other services such as OTC items, with some limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a $375 copay for days 1-6 for Acute and days 1-5 for Psychiatric, and no copay for additional days. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered by VIVA Medicare Plus (HMO). Outpatient Hospital Services have a copay between $0 and $375, while Observation Services have a copay of $375. Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services are also covered. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the VIVA Medicare Plus (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by VIVA Medicare Plus (HMO). Ground and Air Ambulance Services have a $325 copay and no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by VIVA Medicare Plus (HMO), with a $110 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $40, with no coinsurance. Worldwide Emergency Coverage has a $110 copay and no coinsurance, however, Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The VIVA Medicare Plus (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a copay between $0 and $25, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. The plan also covers Mental Health Specialty Services and Psychiatric Services, with a $25 copay for individual and group sessions, and Other Health Care Professional services with a copay between $0 and $25. This plan also covers Additional Telehealth Benefits with a copay between $0 and $25, and Opioid Treatment Program Services with a $25 copay, but does not cover Podiatry Services.
Preventive Services See details
The VIVA Medicare Plus (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services such as health education, in-home safety assessments, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services include hearing exams, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, while prescription hearing aids (all types) have a copay between $500 and $1975, and OTC hearing aids have a copay between $750 and $2850. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams with a copay of $0-$25, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
The VIVA Medicare Plus (HMO) plan covers a variety of dental services, including 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 and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. However, orthodontics is not covered, and there is a $900 annual maximum for all dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the VIVA Medicare Plus (HMO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered prosthetic devices and medical supplies. Diabetic Equipment includes Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the VIVA Medicare Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, while Diagnostic Radiological Services have a copay between $15 and $200, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Plus (HMO) plan with no copay and no coinsurance. 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 Plus (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the VIVA Medicare Plus (HMO) plan. You will have no copay for days 1-20, a $196 copay for days 21-52, and no copay for days 53-100.
Other Services See details
The VIVA Medicare Plus (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $25.00 every three months, and includes 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. Other 1 includes Annual Wellness Visit Enhancement.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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