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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 2026, 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 2026.
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 $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 Classic (HMO) plan features an Enhanced Alternative drug benefit with a $350.00 annual prescription drug deductible. During the initial coverage phase, you will pay a $12.00 copay for Tier 1 preferred generic drugs at standard pharmacies, which drops to a $10.00 copay when using preferred mail order. Tier 2 standard generic drugs carry a $47.00 copay at standard pharmacies, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 42% and 29% coinsurance, respectively. 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 prescriptions. Additionally, individuals who qualify for the full low-income subsidy will benefit from no cost for their Part D premium.
Additional Benefits
The VIVA Medicare Classic (HMO) plan offers comprehensive medical coverage featuring predictable out-of-pocket costs with no deductibles and mostly no coinsurance. Inpatient hospital stays require a $385 daily copay for the first six days and no copay thereafter, while primary care and routine preventive services feature no coinsurance and little to no copays. Additionally, emergency room visits have a $115 copay, which is waived upon admission, and outpatient hospital services require no coinsurance with copays up to $375. Specialty services under this plan include vision, dental, and hearing benefits, with routine exams requiring little to no copays and no coinsurance. The plan also covers up to $950 annually for dental services and provides a $150 annual allowance for eyewear, alongside a $45 quarterly allowance for over-the-counter items. However, some services like diabetic supplies, routine podiatry, and cardiac rehabilitation are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by VIVA Medicare Classic (HMO) with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For covered acute stays, there is a $385 daily copay for days 1 to 6 and no copay for days 7 to 999, while psychiatric stays require a $385 daily copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
VIVA Medicare Classic (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay up to $375 for outpatient hospital and observation services. Outpatient substance abuse services require a $25 copay, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
VIVA Medicare Classic (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
VIVA Medicare Classic (HMO) partially covers Ambulance and Transportation Services, but transportation to plan-approved or any health-related locations is not covered. Covered ground and air ambulance services require prior authorization and have a $250 copay and no coinsurance.
Emergency Services See details
VIVA Medicare Classic (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $40 copay and no coinsurance, while worldwide emergency services are partially covered up to $50,000 with a $115 copay and no coinsurance, excluding worldwide urgent coverage and worldwide emergency transportation.
Primary Care See details
Primary care benefits are partially covered by VIVA Medicare Classic (HMO), as routine chiropractic care and podiatry services are not covered. Covered services require no coinsurance, with copays ranging from no copay up to $40.00.
Preventive Services See details
Preventive services are covered by VIVA Medicare Classic (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, kidney disease education, and other screenings. While fitness benefits and remote access technologies are covered with no copay and no coinsurance, the plan's additional preventive services are only partially covered. Excluded sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by VIVA Medicare Classic (HMO), including routine exams and fitting evaluations with no copay to a $25 copay and no coinsurance. Prescription hearing aids are partially covered with a $500 to $1,975 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models, while over-the-counter hearing aids are covered with a $750 to $2,850 copay and no coinsurance.
Vision Services See details
VIVA Medicare Classic (HMO) covers vision services, including one routine eye exam per year with a copay ranging from no copay to $25 and no coinsurance. Eyewear, including contacts, eyeglasses, and upgrades, is covered up to a $150 annual maximum benefit with no deductible and no coinsurance.
Dental Services See details
VIVA Medicare Classic (HMO) partially covers dental services up to a maximum benefit of $950 every year, though specific copays and coinsurance are not listed. Most diagnostic, preventive, and restorative dental services are covered, but orthodontics is not covered.
Home Infusion bundled Services See details
VIVA Medicare Classic (HMO) covers home infusion bundled services with prior authorization, requiring 0% to 20% coinsurance and no copay for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay along with 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by VIVA Medicare Classic (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by VIVA Medicare Classic (HMO), as diabetic supplies are not covered. Covered services, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, require prior authorization and feature no copay, with coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by VIVA Medicare Classic (HMO) with no coinsurance, though prior authorization is required. Covered diagnostic procedures range from no copay to a $50 copay, diagnostic radiological services require a $10 to $200 copay, therapeutic radiological services cost a $60 copay, and outpatient X-rays have a $10 copay, while lab services are not covered.
Home Health Services See details
Home health services are covered under the VIVA Medicare Classic (HMO) plan, though prior authorization is required. Specific copay and coinsurance cost-sharing details are not provided in the plan documentation.
Cardiac Rehabilitation Services See details
VIVA Medicare Classic (HMO) does not cover Cardiac Rehabilitation Services, as none of the sub-services—including intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services—are covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by VIVA Medicare Classic (HMO) with no coinsurance, requiring no copay for days 1 through 20 and days 64 through 100, and a $218 daily copay for days 21 through 63. The benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, and prior authorization is required.
Other Services See details
VIVA Medicare Classic (HMO) partially covers other services, offering an annual wellness visit enhancement and a $45 quarterly allowance for over-the-counter items. Acupuncture, meal benefits, and dual eligible SNPs with highly integrated services are not covered under this plan.
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