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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 2026, 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 2026.
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 $350.00 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 $9250.00 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 features an Enhanced Alternative drug benefit with a $350.00 annual prescription drug deductible. During the initial coverage phase, Tier 1 preferred generics cost a $10.00 copay for preferred mail or a $12.00 copay at standard pharmacies, while Tier 2 standard generics require a $39.50 or $47.00 copay respectively. Higher tiers require coinsurance, including 42% for Tier 3 preferred brands and 29% for Tier 4 non-preferred drugs at standard pharmacies. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, members who qualify for the full Low-Income Subsidy will benefit from no premium cost for their Part D coverage.
Additional Benefits
The VIVA Medicare Plus (HMO) plan offers comprehensive coverage with many services featuring no coinsurance, including inpatient hospital stays, outpatient care, and emergency visits. Inpatient hospital stays require a $375 copay for the first 5 to 6 days with no copay for subsequent days, while emergency room visits carry a $115 copay. Primary care and routine preventive services are highly accessible, with costs ranging from no copay up to $40. For extra wellness benefits, members receive a $1,000 annual maximum for dental services, a $100 annual eyewear allowance, and a $30 quarterly allowance for over-the-counter items. Routine eye and hearing exams are available with low to no copays, though hearing aids and medical equipment like durable medical devices require copays or a 20% coinsurance. Essential treatments such as dialysis also carry a 20% coinsurance with no copay.
Inpatient Hospital See details
VIVA Medicare Plus (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $375 copay for days 1-6 of acute stays (no copay for days 7-999) and a $375 copay for days 1-5 of psychiatric stays (no copay for days 6-90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by VIVA Medicare Plus (HMO) with no coinsurance, though prior authorization is required for certain services. Outpatient hospital services require a copay of $0 to $365, observation services have a $365 copay per stay, and outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by VIVA Medicare Plus (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
VIVA Medicare Plus (HMO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
VIVA Medicare Plus (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, though worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
VIVA Medicare Plus (HMO) partially covers primary care benefits with copays ranging from no copay up to $40 and no coinsurance, though podiatry services and routine chiropractic care are not covered. Prior authorization is required for mental health specialty, psychiatric, and other health care professional services.
Preventive Services See details
VIVA Medicare Plus (HMO) covers preventive services with no copay or coinsurance for Medicare-covered zero-dollar services, annual physical exams, kidney disease education, and select screenings. Additional preventive services are only partially covered; fitness benefits and remote access technologies are included, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
VIVA Medicare Plus (HMO) covers hearing exams and evaluations with no coinsurance and a copay ranging from no copay to $25. Prescription hearing aids are partially covered with no coinsurance and a copay of $500 to $1,975, excluding inner ear, outer ear, and over-the-ear types, while OTC hearing aids are covered with no coinsurance and a copay of $750 to $2,850.
Vision Services See details
Vision services are covered by VIVA Medicare Plus (HMO), including one annual routine eye exam with a copay ranging from no copay to $25 and no coinsurance. Additionally, members receive a $100 annual allowance for eyewear, including contacts and eyeglasses, with no copay or coinsurance.
Dental Services See details
VIVA Medicare Plus (HMO) dental services are partially covered up to a maximum benefit of $1,000 every year, though orthodontics is not covered. While specific copayment and coinsurance details are not provided in the plan terms, a wide range of preventive, diagnostic, and restorative services are covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by VIVA Medicare Plus (HMO) and require prior authorization, with no copay and no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, which does not count toward the plan-level deductible.
Dialysis Services See details
Dialysis Services are covered by VIVA Medicare Plus (HMO) with 20% coinsurance and no copay. This benefit helps you manage the cost of essential dialysis treatments with clear and predictable cost-sharing.
Medical Equipment See details
VIVA Medicare Plus (HMO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered benefits, including durable medical equipment, prosthetic devices, medical supplies, and therapeutic shoes, require prior authorization and generally carry a 20% coinsurance, though some medical supplies are available with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by VIVA Medicare Plus (HMO), as lab services are not covered. Covered services require prior authorization and have no coinsurance, with copays ranging from no copay to $75 for diagnostic procedures, $15 to $200 for diagnostic radiology, $60 for therapeutic radiology, and $15 for outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the VIVA Medicare Plus (HMO) plan, though prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under VIVA Medicare Plus (HMO), meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
VIVA Medicare Plus (HMO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, though additional days beyond Medicare-covered SNF stays are not covered. There is no coinsurance for this benefit, which features no copay for days 1 to 20 and days 64 to 100, and a daily copay of $218 for days 21 to 63.
Other Services See details
Other services are partially covered by VIVA Medicare Plus (HMO), which offers a $30 quarterly allowance for over-the-counter items and an annual wellness visit enhancement. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
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