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VIVA Medicare Extra Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Extra Care (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Extra Care (HMO D-SNP) in 2025, please refer to our full plan details page.
VIVA Medicare Extra Care (HMO D-SNP) is a HMO D-SNP 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 Extra Care (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
VIVA Medicare Extra Care (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about VIVA Medicare Extra Care (HMO D-SNP).
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 Extra Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $577.00 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 $6750.00 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 Extra Care (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $577. During the initial coverage phase, you will pay 25% coinsurance for your prescriptions at standard pharmacies and mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $40.00.
Additional Benefits
The VIVA Medicare Extra Care (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $395, and also covers emergency and urgent care services. It also includes additional benefits such as hearing and vision services, dental care, and home health services, as well as coverage for medical equipment and ambulance services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a $395 copay for days 1-6 and no copay for days 7-90; additional days for Inpatient Hospital-Acute have no copay. Inpatient Hospital Psychiatric benefits are covered, with a $395 copay for days 1-5 and no copay for days 6-90; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $395, observation services with a $395 copay, ambulatory surgical center services, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the VIVA Medicare Extra Care (HMO D-SNP) plan, but requires prior authorization. The copay for partial hospitalization is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $350 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with services including taxi, rideshare, bus/subway, and medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by VIVA Medicare Extra Care (HMO D-SNP). Emergency Services have a $125 copay, and Worldwide Emergency Coverage also has a $125 copay; both have no coinsurance. Urgently Needed Services have a copay between $0 and $40, with no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The VIVA Medicare Extra Care (HMO D-SNP) plan covers primary care physician services, occupational therapy, physician specialist services with a copay between $0 and $10, mental health and psychiatric individual and group sessions with a $10 copay, physical therapy and speech-language pathology services with a $10 copay, additional telehealth benefits with a copay between $0 and $10, and opioid treatment program services with a $10 copay. Chiropractic routine care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services and annual physical exams. Additional services include Fitness Benefit, Remote Access Technologies, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, while Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The VIVA Medicare Extra Care (HMO D-SNP) plan covers hearing exams with no copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with copays between $300 and $1775, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered with a copay between $250 and $1350.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$10, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The VIVA Medicare Extra Care (HMO D-SNP) plan offers a dental services benefit with a maximum of $1,500 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), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered, while orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the VIVA Medicare Extra Care (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 25% coinsurance, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment, where some services are covered. Diabetic Therapeutic Shoes/Inserts have 10% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
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 $50, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $10 and $50, Therapeutic Radiological Services have a $40 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Extra Care (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
For the VIVA Medicare Extra Care (HMO D-SNP) plan, cardiac rehabilitation services are technically covered, but in practice, none of the sub-services (Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services) are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the VIVA Medicare Extra Care (HMO D-SNP) plan, but require prior authorization. For days 1-20, the copay is $10, for days 21-55 the copay is $196, and for days 56-100 there is no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $65.00 every month. However, 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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