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MyAdvocate Medicare Advantage GOLD (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MyAdvocate Medicare Advantage GOLD (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on MyAdvocate Medicare Advantage GOLD (HMO-POS) in 2026, please refer to our full plan details page.
MyAdvocate Medicare Advantage GOLD (HMO-POS) is a HMO-POS plan offered by Sanford Health available for enrollment in 2026 to people living in Nebraska (partial). The overall rating for this plan is not yet available for 2026.
It's important to know that MyAdvocate Medicare Advantage GOLD (HMO-POS) 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 MyAdvocate Medicare Advantage GOLD (HMO-POS).
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 MyAdvocate Medicare Advantage GOLD (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $69.00. 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 $250.00 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 combined Maximum Out-Of-Pocket cost of $6200.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6200.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 MyAdvocate Medicare Advantage GOLD (HMO-POS) plan features an annual prescription drug deductible of $250. Under this plan, enrollees benefit from no copay on Tier 1 preferred generic drugs and Tier 6 select care drugs for 1-month, 2-month, and 3-month supplies at standard pharmacies and standard mail-order services. Tier 2 generic drugs are also affordable, requiring a copay of $14 for a 1-month supply up to $42 for a 3-month supply. For Tier 3 preferred brand medications, standard pharmacy and mail-order costs are a $47 copay for a 1-month supply and $141 for a 3-month supply. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a 1-month supply. This prescription drug coverage structure helps beneficiaries clearly calculate their potential out-of-pocket costs.
Additional Benefits
The MyAdvocate Medicare Advantage GOLD (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $390 daily copay for the first four days followed by no copay for days five through ninety. Specialist visits, urgent care, and diagnostic procedures are also highly accessible, requiring low copays between $25 and $35 with no coinsurance. In addition to medical care, the plan features valuable wellness benefits such as no copay for routine vision and hearing exams, a $300 eyewear allowance, and up to $1,250 in preventive dental care. Members also receive a $95 quarterly allowance for over-the-counter items with no copay or coinsurance. While major services like dialysis and medical equipment require a 20% coinsurance, other services such as routine transportation and cardiac rehabilitation are not covered.
Inpatient Hospital See details
Inpatient hospital care is covered by MyAdvocate Medicare Advantage GOLD (HMO-POS) with no coinsurance and a copay of $390 per day for days 1 through 4, followed by no copay for days 5 through 90. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
MyAdvocate Medicare Advantage GOLD (HMO-POS) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital and observation services, and a $275 copay for ambulatory surgical center services. Outpatient substance abuse services carry a $25 copay with no coinsurance, while outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the MyAdvocate Medicare Advantage GOLD (HMO-POS) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by MyAdvocate Medicare Advantage GOLD (HMO-POS) with a $275.00 copay and no coinsurance for ground and air ambulance services, which require prior authorization. Routine transportation services are not covered in practice, as trips to plan-approved or any health-related locations are excluded.
Emergency Services See details
Emergency Services under the MyAdvocate Medicare Advantage GOLD (HMO-POS) plan are covered with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a maximum benefit of $250.
Primary Care See details
Primary care benefits under MyAdvocate Medicare Advantage GOLD (HMO-POS) are partially covered, as podiatry and chiropractic services are not covered. Covered services include primary care doctor visits with no copay and no coinsurance, while specialist visits, therapies, and mental health services require copays ranging from $25 to $35 with no coinsurance.
Preventive Services See details
Preventive services are partially covered under the MyAdvocate Medicare Advantage GOLD (HMO-POS) plan with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and memory fitness. However, the plan does not cover 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 benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, telemonitoring, remote access technologies, home safety devices, and counseling services.
Hearing Services See details
MyAdvocate Medicare Advantage GOLD (HMO-POS) provides hearing services with no copay and no coinsurance for annual routine exams and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $295 to $1,495 for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by MyAdvocate Medicare Advantage GOLD (HMO-POS), offering annual routine and diagnostic eye exams with no copay and no coinsurance. Eyewear is partially covered with no copay, providing coverage for individual eyeglass lenses and frames (up to $300) and contact lenses (up to $300 with a 20% coinsurance), while upgrades and combined eyeglasses are not covered.
Dental Services See details
MyAdvocate Medicare Advantage GOLD (HMO-POS) partially covers dental services with no copays for covered benefits, offering no coinsurance for preventive care up to $1,250 annually and 20% to 50% coinsurance for comprehensive and Medicare-covered dental. Fluoride treatments, other diagnostic or preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MyAdvocate Medicare Advantage GOLD (HMO-POS) with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the MyAdvocate Medicare Advantage GOLD (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
MyAdvocate Medicare Advantage GOLD (HMO-POS) covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, as durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
MyAdvocate Medicare Advantage GOLD (HMO-POS) partially covers diagnostic services with prior authorization, offering diagnostic procedures for a $25 copay and no coinsurance, while lab services are not covered. Radiological services under this plan require prior authorization and include a $25 copay for diagnostic radiological services, a 20% coinsurance for therapeutic radiological services, and a $20 copay with coinsurance for outpatient X-rays.
Home Health Services See details
Home health services are covered by MyAdvocate Medicare Advantage GOLD (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the MyAdvocate Medicare Advantage GOLD (HMO-POS) plan, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by MyAdvocate Medicare Advantage GOLD (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $196 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under MyAdvocate Medicare Advantage GOLD (HMO-POS), as acupuncture, meal benefits, and other miscellaneous services are not covered. However, the plan covers over-the-counter (OTC) items with no copay and no coinsurance, providing a maximum benefit of $95 every three months.
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