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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 2026, 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 2026.
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 $25.00. 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 $100.00 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 $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 features an Enhanced Alternative drug benefit with a prescription drug deductible of $100.00. During the initial coverage phase, generic prescription drugs carry a copay as low as $10.00 for preferred mail orders, while standard generic drugs have a copay of up to $47.00. Brand-name and non-preferred medications are covered via coinsurance, ranging from 31% to 42% depending on the drug tier and pharmacy type. Once your yearly out-of-pocket drug expenses reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Furthermore, beneficiaries who qualify for the low-income subsidy will pay no premium for their Part D coverage. This plan ensures clear cost-sharing limits to help you manage your healthcare budget effectively.
Additional Benefits
The VIVA Medicare Infirmary Health Advantage (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for preventive services, routine eye exams, and initial skilled nursing facility stays. For inpatient hospital care, members pay a $325 daily copay for the first six days and no copay for days seven through 90. Primary care and specialist visits are highly affordable, with copays ranging from no copay up to $40. This plan also includes valuable supplemental benefits, such as up to $1,650 annually for dental care and a $300 yearly allowance for eyewear with no copay. Members receive a $40 quarterly allowance for over-the-counter items, while medical equipment and dialysis services require a coinsurance of up to 20 percent. Emergency care is covered with a $130 copay, providing reliable protection at home and worldwide.
Inpatient Hospital See details
Inpatient hospital services are partially covered by VIVA Medicare Infirmary Health Advantage (HMO), with acute and psychiatric stays requiring a $325 daily copay for days 1-6 and no copay for days 7-90 with no coinsurance. Additional acute days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by VIVA Medicare Infirmary Health Advantage (HMO) with no coinsurance, featuring copays ranging from no copay to $325 for outpatient hospital services and $15 for substance abuse sessions. Observation services require a $325 copay per stay, while outpatient blood services have no deductible and require no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by VIVA Medicare Infirmary Health Advantage (HMO) with a $55 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by VIVA Medicare Infirmary Health Advantage (HMO), featuring a $280 copay and no coinsurance for ground and air ambulance services, which require prior authorization. Routine transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
VIVA Medicare Infirmary Health Advantage (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 limit, offering worldwide emergency coverage with a $130 copay and no coinsurance, while worldwide urgent coverage and worldwide emergency transportation are not covered.
Primary Care See details
Primary Care benefits under VIVA Medicare Infirmary Health Advantage (HMO) are partially covered, as podiatry services and routine chiropractic care are not covered. Most covered services, including specialist visits, therapy, and telehealth, require copays ranging from no copay to $40 and no coinsurance.
Preventive Services See details
VIVA Medicare Infirmary Health Advantage (HMO) covers Medicare-approved zero-dollar preventive services with no copay and no coinsurance, alongside annual physical exams, glaucoma screenings, and kidney disease education. Additional supplemental benefits are partially covered, offering fitness benefits and remote access technologies, while services like health education, weight management, and therapeutic massage are not covered.
Hearing Services See details
VIVA Medicare Infirmary Health Advantage (HMO) partially covers hearing services, as prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. Routine exams and fittings have a $0 to $15 copay, while covered prescription and OTC hearing aids require copays ranging from $500 to $2,850, with no deductibles or coinsurance.
Vision Services See details
Vision services are covered by VIVA Medicare Infirmary Health Advantage (HMO), featuring one routine eye exam per year with no copay and no coinsurance. Other eye exams have a copay of up to $15 with no coinsurance, and eyewear is covered up to a $300 annual maximum with no deductible, no copay, and no coinsurance.
Dental Services See details
Dental services are partially covered by VIVA Medicare Infirmary Health Advantage (HMO) up to a maximum benefit of $1,650 every year. While a wide range of preventive, diagnostic, and restorative services are covered, orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by VIVA Medicare Infirmary Health Advantage (HMO), with prior authorization required. Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by VIVA Medicare Infirmary Health Advantage (HMO) with no copay and a 20% coinsurance. This benefit ensures you have access to necessary dialysis treatments with clear and predictable out-of-pocket costs.
Medical Equipment See details
Medical equipment is partially covered by VIVA Medicare Infirmary Health Advantage (HMO), with diabetic supplies being excluded from coverage. Covered medical equipment, including durable medical equipment, prosthetics, and therapeutic shoes, requires prior authorization and carries a 0% to 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
VIVA Medicare Infirmary Health Advantage (HMO) partially covers diagnostic and radiological services, as lab services are not covered. Covered benefits require prior authorization and have no coinsurance, with copays ranging from no copay to $50 for diagnostic tests, $10 to $125 for diagnostic radiology, $60 for therapeutic radiology, and $10 for outpatient X-rays.
Home Health Services See details
VIVA Medicare Infirmary Health Advantage (HMO) covers Home Health Services, though prior authorization is required to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically offered by VIVA Medicare Infirmary Health Advantage (HMO), but in practice only some services are covered, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Consequently, there are no copay or coinsurance benefits available for these rehabilitation services under this plan.
Skilled Nursing Facility (SNF) See details
VIVA Medicare Infirmary Health Advantage (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and days 51 to 100, and a $218 daily copay for days 21 to 50. Prior authorization is required, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by VIVA Medicare Infirmary Health Advantage (HMO), which provides a $40 quarterly allowance for over-the-counter (OTC) items and an Annual Wellness Visit Enhancement. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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