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VIVA Medicare Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Classic (HMO) in 2025, please refer to our full plan details page.
VIVA Medicare Classic (HMO) is a HMO plan offered by Triton Health Systems, L.L.C. available for enrollment in 2025 to people living in Jackson, Limestone, Madison, Marshall and Morgan. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that VIVA Medicare Classic (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 Classic (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 Classic (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 Classic (HMO) plan has an enhanced alternative drug benefit. The plan has a $300 deductible for prescription drugs. During the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a standard generic drug has a $47 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The VIVA Medicare Classic (HMO) plan offers comprehensive coverage with a variety of benefits. You'll have access to inpatient hospital care with a copay, outpatient services, and emergency services. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with specific copays or coinsurance amounts depending on the service. Additional benefits of the VIVA Medicare Classic (HMO) plan include home health services with no copay, skilled nursing facility stays with a copay, and coverage for medical equipment and diagnostic services. The plan also provides coverage for home infusion services and dialysis services. There is also coverage for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $385 copay for days 1-6, and no copay for days 7-90, and no copay for days 91-999. For Inpatient Hospital Psychiatric, you will pay a $385 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $385, observation services with a $385 copay, ambulatory surgical center services, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the VIVA Medicare Classic (HMO) plan, but prior authorization is required. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the VIVA Medicare Classic (HMO) plan. Ground and Air Ambulance Services have a $350 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 Classic (HMO). Emergency Services has a $110 copay, Urgently Needed Services has a copay between $0 and $40, and Worldwide Emergency Coverage has a $110 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The VIVA Medicare Classic (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 $0-$25 copay, Mental Health Specialty Services with a $25 copay, Other Health Care Professional services with a $0-$25 copay, Psychiatric Services with a $25 copay, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a $0-$25 copay, and Opioid Treatment Program Services with a $25 copay; however, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The VIVA Medicare Classic (HMO) plan covers preventive services, including annual physical exams, with additional services not typically covered by Medicare. Fitness benefits and remote access technologies are covered. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay, and fitting/evaluation for hearing aids, both covered once per year. Prescription hearing aids are partially covered, with a copay of $500 to $1975 per year. OTC hearing aids are covered with a copay of $750 to $2850 per year for a quantity of 2.
Vision Services See details
Vision services are covered, including eye exams with a copay of $0-$25, eyewear with a combined maximum benefit of $150 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
The VIVA Medicare Classic (HMO) plan offers a dental benefit with a maximum plan benefit of $850 per year. 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 are covered, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the VIVA Medicare Classic (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance between 0% and 20%. Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and radiological services, are covered by the VIVA Medicare Classic (HMO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $50, while Diagnostic Radiological Services have a minimum copay of $10 and a maximum copay of $200, Therapeutic Radiological Services have a minimum copay of $60, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Classic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the VIVA Medicare Classic (HMO) plan. This includes 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 by the VIVA Medicare Classic (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 50-100, but there is a $196 copay for days 21-49. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The VIVA Medicare Classic (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $40.00 every three months, including 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.
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