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FHCP Medicare Premier Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for FHCP Medicare Premier Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on FHCP Medicare Premier Advantage (HMO) in 2025, please refer to our full plan details page.
FHCP Medicare Premier Advantage (HMO) is a HMO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Counties: BRE, FLA, SEM, SJO and VOL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that FHCP Medicare Premier 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 FHCP Medicare Premier 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 FHCP Medicare Premier 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.
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 $295.00 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 $5100.00 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 FHCP Medicare Premier Advantage (HMO) plan has a $295.00 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $5.00 copay at a preferred pharmacy and $20.00 at a standard pharmacy. For specialty tier drugs, there is no copay. For preferred brand and non-preferred drugs, you will pay 25% and 29% coinsurance, respectively.
Additional Benefits
The FHCP Medicare Premier Advantage (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by the type of service. Emergency and urgent care services have copays, and ambulance services have a $265 copay. This plan offers no copay for primary care, preventive services, and home health services, and also has no copay for many vision and dental services. Hearing exams have a $45 copay, and prescription hearing aids are covered up to $300 per year. The plan also covers services such as diagnostic and radiological services, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits for FHCP Medicare Premier Advantage (HMO) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you will pay a $320 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services for the FHCP Medicare Premier Advantage (HMO) plan includes coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a $250 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services include individual and group sessions with a $30 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
FHCP Medicare Premier Advantage (HMO) covers partial hospitalization with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the FHCP Medicare Premier Advantage (HMO) plan, with a $265 copay for both ground and air ambulance services and 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 FHCP Medicare Premier Advantage (HMO) plan. Emergency Services have a $125 copay, and no coinsurance; Urgently Needed Services have a $0-$30 copay, and no coinsurance; Worldwide Emergency Coverage has a $125 copay, and no coinsurance; Worldwide Urgent Coverage has a $30 copay, and no coinsurance; and Worldwide Emergency Transportation has a $265 copay, and no coinsurance.
Primary Care See details
The FHCP Medicare Premier Advantage (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, and physician specialist services with a copay between $0 and $30. Mental health and psychiatric services have a $30 copay for individual and group sessions, while physical therapy and speech-language pathology services have a copay between $0 and $20. Additionally, this plan offers additional telehealth benefits and opioid treatment program services, both with a $30 copay.
Preventive Services See details
Preventive Services include Medicare-covered services, with no copay. Additional preventive services are covered, but annual physical exams are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids are covered with a maximum benefit of $300 per year.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $30, with routine eye exams covered with no copay. Eyewear is partially covered, with eyeglasses (lenses and frames) covered with no copay and a maximum plan benefit of $180 every two years, while contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The FHCP Medicare Premier Advantage (HMO) plan covers dental services including Medicare Dental Services with a $20 copay, and other dental services with no copay. Oral exams and dental X-rays are covered, and Prosthodontics, removable and Oral and Maxillofacial Surgery are covered with no copay, while fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, with a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for all services. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the FHCP Medicare Premier Advantage (HMO) plan and require a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the FHCP Medicare Premier Advantage (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $200, Lab Services have no copay, Diagnostic Radiological Services have a copay between $10 and $200, Therapeutic Radiological Services have a copay between $10 and $50, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the FHCP Medicare Premier Advantage (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the FHCP Medicare Premier Advantage (HMO) plan. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the FHCP Medicare Premier Advantage (HMO) plan. There is no copay for days 1-20, and a $172 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and more. No authorization or referral is required for these services.
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