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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 $2.00. 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 is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For the initial coverage phase, copays range from $10 to $47 for generic drugs, while brand-name drugs have a 42% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs.
Additional Benefits
The VIVA Medicare Plus (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and coverage for ambulance and emergency services. Primary care, preventive services, and dental services are covered with no copay for some services, while others have a copay or coinsurance. Additional benefits include hearing and vision services, with varying copays for exams and eyewear. The plan also covers home health services, skilled nursing facility stays, and home infusion services. However, some services like cardiac rehabilitation, certain outpatient services, and some other services are not covered.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered under the VIVA Medicare Plus (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $375 copay for days 1-6, and no copay for days 7-90, with additional days 91-999 covered with no copay; however, non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $375 copay for days 1-5, and no copay for days 6-90, with additional days and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $375, observation services have a $375 copay, and outpatient substance abuse individual and group sessions have a $25 copay. Outpatient blood services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the VIVA Medicare Plus (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 by the VIVA Medicare Plus (HMO) plan. Ground and air ambulance services each have a $325 copay, with no coinsurance, while 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 VIVA Medicare Plus (HMO). Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $40 and no coinsurance, and Worldwide Emergency Coverage has a $110 copay and no coinsurance. 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 mental health specialty services with a $25 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $25 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
VIVA Medicare Plus (HMO) covers preventive services with no copay, including annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) with a copay between $500 and $1975. OTC hearing aids have a copay between $750 and $2850.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$25, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, and has a combined maximum benefit of $100 per year.
Dental Services See details
The VIVA Medicare Plus (HMO) plan covers a maximum of $835 per year for dental services, including oral exams, dental x-rays, and more with no copay. 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, you will pay a $35 copay and between 0% and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the VIVA Medicare Plus (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits under the VIVA Medicare Plus (HMO) plan include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies has a coinsurance for Medicare-covered devices and supplies, and Diabetic Therapeutic Shoes/Inserts has a 20% 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 $75, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $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 under the VIVA Medicare Plus (HMO) plan with no copay and no coinsurance, but require authorization. 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 VIVA Medicare Plus (HMO), but require prior authorization. For days 1-20, there is no copay, for days 21-52, the copay is $196, and for days 53-100, there is no copay; additional and non-Medicare-covered SNF days are not covered.
Other Services See details
Under Other Services, acupuncture, meal benefits, 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. Over-the-counter (OTC) items are covered with a maximum benefit of $25 every three months, and the plan also offers Nicotine Replacement Therapy (NRT) and Naloxone as a Part C OTC benefit. Other 1 includes Annual Wellness Visit Enhancement.
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