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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 $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 $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 an annual prescription drug deductible of $350.00. During the initial coverage phase, you will pay a copay of $10.00 for Tier 1 preferred generics through preferred mail order, or $12.00 at standard pharmacies and standard mail. For brand-name and non-preferred drugs, the plan charges a 42% coinsurance for Tier 3 preferred brands and a 29% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. Additionally, beneficiaries who qualify for the low-income subsidy can receive a full premium reduction, lowering their Part D premium to $0.00. This structured coverage helps you easily forecast and manage your medication costs throughout the year.
Additional Benefits
The VIVA Medicare Plus (HMO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for many core services. Inpatient hospital stays require a $375 daily copay for the first few days and no copay for longer stays, while emergency room visits have a $115 copay that is waived if you are admitted. Outpatient services, primary care, and specialist visits are also highly affordable, with copays ranging from no copay up to $365 depending on the specific service. Preventive care and annual physicals are fully covered with no copays or coinsurance, helping you maintain your health at no extra cost. The plan also includes valuable supplemental benefits, such as dental coverage up to $700 annually, a $100 yearly eyewear allowance, and routine hearing exams with no copay or low copays. For specialized needs like medical equipment and dialysis, you will generally pay no copay and up to 20% coinsurance.
Inpatient Hospital See details
VIVA Medicare Plus (HMO) partially covers inpatient hospital benefits, featuring a $375 daily copay for days 1 to 6 of acute care (no copay for days 7 to 999) and days 1 to 5 of psychiatric care (no copay for days 6 to 90), with no coinsurance required for either service. However, upgrades and non-Medicare-covered stays for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Outpatient services are covered by VIVA Medicare Plus (HMO) with no coinsurance. Outpatient hospital services range from no copay to a $365 copay, observation services require a $365 copay per stay, and outpatient substance abuse sessions have a $25 copay. Ambulatory surgical center and blood services are also covered with no deductibles.
Partial Hospitalization See details
VIVA Medicare Plus (HMO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under VIVA Medicare Plus (HMO), as transportation to plan-approved or any health-related locations is not covered. Covered ground and air ambulance services require a $290 copay and no coinsurance.
Emergency Services See details
VIVA Medicare Plus (HMO) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with no copay to a $40 copay, both with no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with a $115 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
VIVA Medicare Plus (HMO) partially covers primary care benefits with copayments ranging from no copay up to $40 and no coinsurance. Covered services include specialist visits, therapy, and telehealth, while podiatry services and routine chiropractic care are not covered.
Preventive Services See details
VIVA Medicare Plus (HMO) offers coverage for Medicare-covered preventive services, including annual physicals and screenings, with no copays or coinsurance. Additional benefits like physical and memory fitness programs are covered, but several supplemental services, such as health education, weight management, and in-home safety assessments, are not covered.
Hearing Services See details
VIVA Medicare Plus (HMO) partially covers hearing services, offering annual routine exams with a $0 to $25 copay and fitting evaluations with no copay, both featuring no coinsurance. The plan covers up to two OTC hearing aids per year with a $750 to $2,850 copay and up to two prescription hearing aids with a $500 to $1,975 copay, with no coinsurance for either, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by VIVA Medicare Plus (HMO), including one routine eye exam per year with no coinsurance and a copay ranging from no copay up to $25. Additionally, the plan offers a combined maximum benefit of $100 every year for eyewear, including contacts and eyeglasses, with no deductible or coinsurance.
Dental Services See details
Dental services are partially covered by VIVA Medicare Plus (HMO) up to a maximum of $700 every year, though orthodontics is not covered. This coverage includes unlimited preventive and comprehensive care such as cleanings, exams, and restorative services, with no copay or coinsurance details specified in the plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by VIVA Medicare Plus (HMO) with prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the VIVA Medicare Plus (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by VIVA Medicare Plus (HMO), with durable medical equipment, prosthetic devices, and medical supplies requiring no copay and between no coinsurance and 20% coinsurance. Diabetic equipment is partially covered, featuring no copay and 20% coinsurance for therapeutic shoes and inserts, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
VIVA Medicare Plus (HMO) partially covers diagnostic and radiological services with no coinsurance, though lab services are not covered and prior authorization is required. Covered services require 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, but prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under VIVA Medicare Plus (HMO), as the plan does not cover any sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation. Because these services are not covered, there are no copays or coinsurance options available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered under VIVA Medicare Plus (HMO) because additional days beyond Medicare-covered stays are not covered. There is no coinsurance for these services, which feature no copay for days 1 to 20 and days 64 to 100, and a $218 copay for days 21 to 63.
Other Services See details
Other Services are partially covered by VIVA Medicare Plus (HMO), which offers a quarterly over-the-counter (OTC) item allowance of $30 and an Annual Wellness Visit Enhancement, though specific copay and coinsurance details are not specified. Acupuncture, meal benefits, and dual eligible SNP services are not covered under this plan.
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