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VIVA Medicare Infirmary Health Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for VIVA Medicare Infirmary Health Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on VIVA Medicare Infirmary Health Advantage (HMO) in 2025, please refer to our full plan details page.
VIVA Medicare Infirmary Health Advantage (HMO) is a HMO plan offered by Triton Health Systems, L.L.C. available for enrollment in 2025 to people living in Baldwin and Mobile Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that VIVA Medicare Infirmary Health Advantage (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 Infirmary Health Advantage (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 Infirmary Health Advantage (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 $33.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6500.00 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 Infirmary Health Advantage (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you may pay a $12 copay for a preferred generic drug at a standard pharmacy or 46% coinsurance for a preferred brand drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The VIVA Medicare Infirmary Health Advantage (HMO) plan provides comprehensive coverage with a range of benefits. Inpatient hospital stays have a $325 copay for the first six days, with no copay for subsequent days. Outpatient services and primary care visits have copays that vary, while emergency services have a $125 copay. The plan also includes dental services up to $1650 per year, vision care with varying copays, and home health services with no copay. Hearing services include no copay for hearing exams, and copays for hearing aids that vary. Additionally, the plan covers home infusion, dialysis, and medical equipment with coinsurance costs.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-6, there is a $325 copay, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, individual and group sessions for outpatient substance abuse have a $15 copay, and outpatient blood services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan, but requires prior authorization. The plan has a copay of $55 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground and air ambulance services have a $300 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay with no coinsurance, while 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 Infirmary Health Advantage (HMO) plan covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay, while routine chiropractic care is not covered. For occupational therapy services, the copay is $15. Physician specialist services have a copay between $0 and $15, while individual and group sessions for mental health and psychiatric services have a $15 copay. Physical therapy and speech-language pathology services have a $15 copay, and additional telehealth benefits have a copay between $0 and $15. Opioid treatment program services have a $15 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan. The plan does not cover health education, in-home safety assessments, personal emergency response systems, 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 benefits, 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.
Hearing Services See details
Hearing Services include hearing exams with no copay, Routine Hearing Exams with a copay between $0 and $15, and Fitting/Evaluation for Hearing Aids with a copay between $0 and $15. Prescription Hearing Aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $500 and $1975, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids have a copay between $750 and $2850.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$15, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $300 every year.
Dental Services See details
The VIVA Medicare Infirmary Health Advantage (HMO) plan covers dental services with a maximum benefit of $1650 per year, including oral exams, dental x-rays, and other services with no copay or coinsurance. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay, plus 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the VIVA Medicare Infirmary Health Advantage (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance, while Medical Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Lab Services are not. Diagnostic Procedures/Tests have a copay between $0 and $50, Diagnostic Radiological Services have a copay up to $125, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the VIVA Medicare Infirmary Health Advantage (HMO) plan, but require prior authorization. For days 1-20 and 45-100, there is no copay, but for days 21-44, the copay is $196.
Other Services See details
The VIVA Medicare Infirmary Health Advantage (HMO) plan's other services benefit covers over-the-counter items with a maximum benefit of $40 every three months, including nicotine replacement therapy and naloxone coverage. Acupuncture, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment services, private duty nursing services, case management, institution for mental disease services, services in an intermediate care facility, tobacco cessation counseling, 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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