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MyAdvocate Medicare Advantage SILVER (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for MyAdvocate Medicare Advantage SILVER (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 SILVER (HMO-POS) in 2026, please refer to our full plan details page.
MyAdvocate Medicare Advantage SILVER (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 SILVER (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 SILVER (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 SILVER (HMO-POS), 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.
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 $400.00 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 $7500.00 (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 $7500.00 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 SILVER (HMO-POS) plan features an annual drug deductible of $400. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy and mail-order copays are $14 for a 1-month supply, $28 for a 2-month supply, and $42 for a 3-month supply. Tier 3 preferred brand drugs require a copay of $47 for a 1-month supply up to $141 for a 3-month supply. Non-preferred drugs in Tier 4 carry a 50% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply.
Additional Benefits
The MyAdvocate Medicare Advantage SILVER (HMO-POS) plan offers comprehensive medical coverage with no copays or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, patients pay a $35 copay, while inpatient hospital stays require a $375 daily copay for the first five days and no copay for subsequent days up to day 90. Outpatient hospital services carry a $375 copay, and emergency room visits cost $130, which is waived if you are admitted within 24 hours. The plan also features dental, vision, and hearing benefits, including routine exams at no copay, though comprehensive dental care and contact lenses require coinsurance. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $203 daily copay up to 100 days. Additionally, members receive an over-the-counter benefit of up to $75 every three months with no copay or coinsurance to help cover essential health products.
Inpatient Hospital See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) covers outpatient services with no coinsurance, featuring a $375 copay for outpatient hospital and observation services, and a $300 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the MyAdvocate Medicare Advantage SILVER (HMO-POS) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $45 copay, with no coinsurance for either and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit limit of $250.
Primary Care See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, mental health, and psychiatric services require a $35 copay and no coinsurance. Chiropractic and podiatry services are not covered, but telehealth benefits are available with a copay ranging from $0 to $375 and 0% to 20% coinsurance.
Preventive Services See details
Preventive Services are covered by MyAdvocate Medicare Advantage SILVER (HMO-POS) with no copay and no coinsurance for annual exams, kidney disease education, and screenings. Additional preventive services are partially covered, including memory fitness and enhanced disease management, but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, 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, telemonitoring, remote access technologies, home safety modifications, or counseling.
Hearing Services See details
Hearing services are partially covered by MyAdvocate Medicare Advantage SILVER (HMO-POS), offering annual routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295 to $1,495, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by the MyAdvocate Medicare Advantage SILVER (HMO-POS) plan, offering annual routine and diagnostic eye exams with no copay and no coinsurance. Eyewear is partially covered with no copay and a 20% coinsurance for contact lenses, though upgrades and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) dental services are partially covered with no copays, featuring no coinsurance for preventive cleanings and exams, 20% coinsurance for Medicare-covered dental, and 20% to 50% coinsurance for comprehensive care up to a $1,000 annual limit. Specific services including fluoride treatments, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by MyAdvocate Medicare Advantage SILVER (HMO-POS) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by MyAdvocate Medicare Advantage SILVER (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by MyAdvocate Medicare Advantage SILVER (HMO-POS) with no copay and 20% coinsurance, though prior authorization is required. This benefit is partially covered as durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by MyAdvocate Medicare Advantage SILVER (HMO-POS), as lab services are not covered and prior authorization is required. Covered diagnostic procedures and diagnostic radiological services require a $35 copay with no coinsurance, while outpatient X-rays require a $25 copay and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) does not cover Cardiac Rehabilitation Services. This includes standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, which are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by MyAdvocate Medicare Advantage SILVER (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $203 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the standard 100-day limit are not covered.
Other Services See details
MyAdvocate Medicare Advantage SILVER (HMO-POS) partially covers other services, offering an over-the-counter (OTC) benefit of up to $75 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and other miscellaneous services are not covered under this plan.
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