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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 2026, 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 2026.
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 $27.70. 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 $615.00 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 features a defined standard prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where you share the cost of your medications until your total drug costs reach $2,100.00. Additionally, beneficiaries who qualify for the low-income subsidy, or Extra Help, can have their Part D premium reduced to $27.70. Once your yearly out-of-pocket prescription drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. This means there is no copay for your covered prescriptions for the rest of the calendar year, though you may still pay a portion for excluded drugs. Prospective members should check the plan's formulary to confirm coverage for their specific medications.
Additional Benefits
VIVA Medicare Extra Care (HMO D-SNP) offers comprehensive medical coverage with predictable cost-sharing, featuring no copay to a $15 copay for primary care visits and no copay to a $395 copay for outpatient hospital services. Emergency care is covered with a $130 copay, while inpatient hospital stays require a $400 copay for the first several days and no copay for the remaining covered days. Most of these core medical services, including outpatient care, partial hospitalization, and diagnostic tests, carry no coinsurance. This plan also provides valuable supplemental benefits, including up to $1,500 annually for dental services and a $200 yearly allowance for eyewear with no copay or coinsurance. Routine eye and hearing exams feature no copay to a $15 copay, and members receive up to 24 one-way trips to plan-approved locations alongside a $65 monthly allowance for over-the-counter items. While specialized medical equipment and dialysis require coinsurance ranging from 10% to 25%, routine preventive services and annual physicals are fully covered with no copay or coinsurance.
Inpatient Hospital See details
VIVA Medicare Extra Care (HMO D-SNP) partially covers inpatient hospital services, requiring a $400 copay for days 1 through 6 of acute care and days 1 through 5 of psychiatric care, with no copay for remaining covered days and no coinsurance. 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
VIVA Medicare Extra Care (HMO D-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a copay ranging from no copay to $395 and observation services with a $395 copay per stay. Outpatient substance abuse services require a $15 copay and no coinsurance, while ambulatory surgical center and blood services are covered with no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by VIVA Medicare Extra Care (HMO D-SNP) with a $55 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by VIVA Medicare Extra Care (HMO D-SNP), though transportation is only partially covered as transportation to any health-related location is not covered. Ground and air ambulance services require a $335 copay and no coinsurance, while up to 24 one-way trips per year to plan-approved locations are covered.
Emergency Services See details
VIVA Medicare Extra Care (HMO D-SNP) covers emergency services with a $130 copay and urgently needed services with no copay to a $40 copay, both with no coinsurance. Worldwide emergency services are partially covered up to $50,000 with a $130 copay and no coinsurance, but worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits are partially covered by VIVA Medicare Extra Care (HMO D-SNP), as routine chiropractic care and podiatry services are not covered. Covered services require no coinsurance, with copays ranging from no copay up to $15 for most services and up to $40 for telehealth.
Preventive Services See details
Preventive Services are covered under VIVA Medicare Extra Care (HMO D-SNP) with no copay or coinsurance for Medicare-covered zero-dollar services, annual physicals, kidney disease education, and other select screenings. Additional preventive services are partially covered, including fitness benefits and remote access technologies, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, home/bathroom safety devices, and counseling are not covered.
Hearing Services See details
VIVA Medicare Extra Care (HMO D-SNP) hearing services are partially covered, with no coverage for inner ear, outer ear, and over-the-ear prescription hearing aids. Covered benefits feature no coinsurance and include annual exams and fittings with no copay up to a $15 copay, plus up to two OTC or prescription hearing aids per year with copays ranging from $300 to $2,700.
Vision Services See details
VIVA Medicare Extra Care (HMO D-SNP) covers annual routine eye exams with a copay of $0 to $15 and no coinsurance. Eyewear is also covered with no deductible, copay, or coinsurance up to a combined maximum benefit of $200 every year.
Dental Services See details
VIVA Medicare Extra Care (HMO D-SNP) dental services are partially covered up to a maximum annual benefit of $1,500, with orthodontics being the only sub-service not covered. Covered benefits include unlimited oral exams, cleanings, x-rays, restorative care, and dental implants.
Home Infusion bundled Services See details
VIVA Medicare Extra Care (HMO D-SNP) covers home infusion bundled services with prior authorization required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by VIVA Medicare Extra Care (HMO D-SNP) with a 20% coinsurance and no copay.
Medical Equipment See details
Medical equipment benefits are covered by VIVA Medicare Extra Care (HMO D-SNP) with no copays, requiring a 25% coinsurance for durable medical equipment, a 20% coinsurance for prosthetic devices, and no coinsurance to 20% coinsurance for medical supplies. Diabetic equipment is partially covered, as diabetic supplies are not covered, though diabetic therapeutic shoes and inserts are covered with no copay and a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by VIVA Medicare Extra Care (HMO D-SNP), as lab services are not covered. Covered diagnostic procedures range from no copay to a $50 copay, while radiological services require a $10 to $50 copay, with no coinsurance for either service.
Home Health Services See details
Home Health Services are covered under the VIVA Medicare Extra Care (HMO D-SNP) plan, though prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
VIVA Medicare Extra Care (HMO D-SNP) does not cover cardiac rehabilitation services. This includes standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by VIVA Medicare Extra Care (HMO D-SNP), as additional days beyond Medicare-covered care are not covered. Covered stays require prior authorization and have no coinsurance, with a daily copay of $10 for days 1-20, $218 for days 21-51, and no copay for days 52-100.
Other Services See details
VIVA Medicare Extra Care (HMO D-SNP) partially covers Other Services, providing a $65 monthly allowance for over-the-counter items and an Annual Wellness Visit Enhancement with no copay or coinsurance. Acupuncture, meal benefits, and highly integrated dual-eligible services are not covered under this plan.
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