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Premier Care (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Premier Care (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Premier Care (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
Premier Care (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by Curana Health Holdings, LLC available for enrollment in 2025 to people living in Virginia (partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Premier Care (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Premier Care (HMO-POS I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Premier Care (HMO-POS I-SNP).
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 Premier Care (HMO-POS I-SNP), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3100.00 (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 $3100.00 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 Premier Care (HMO-POS I-SNP) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay a copay for your prescriptions. For standard pharmacies, preferred generic drugs have a $15 copay, standard generic drugs have a $45 copay, and preferred brand drugs have a $95 copay, while non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, you will have no copay.
Additional Benefits
The Premier Care (HMO-POS I-SNP) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays and coinsurance depending on the service. The plan also covers services like primary care, hearing, vision, and dental, with specific cost-sharing amounts for each. Many services have a copay or coinsurance, so it's essential to understand the costs associated with each benefit. This plan provides additional benefits like ambulance services, emergency services, and home health services, with specific coverage details for each. There is also coverage for medical equipment, dialysis, and diagnostic services with coinsurance requirements. Some services, like cardiac rehabilitation and certain transportation services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-10, and no copay for days 11-90. For Inpatient Hospital Psychiatric, you will pay a $195 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $225, and Observation Services with a $100 copay. Ambulatory Surgical Center (ASC) Services have a 20% coinsurance. Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Premier Care (HMO-POS I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Premier Care (HMO-POS I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay for ambulance services. Transportation Services - Plan Approved Health-related Location and Transportation Services - Any Health-related Location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the Premier Care (HMO-POS I-SNP) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Premier Care (HMO-POS I-SNP) plan. Chiropractic services have a 20% coinsurance, and routine chiropractic care has a $30 copay for up to 12 visits per year. Physician Specialist Services have a $5 copay, and Individual Mental Health Sessions have a $20 copay, while Group Mental Health Sessions have a $10 copay. Additional Telehealth Benefits have a copay between $0 and $20. Routine Foot Care has a 20% coinsurance. Other Health Care Professional and Psychiatric Services have a minimum 20% coinsurance and a maximum 20% coinsurance.
Preventive Services See details
Preventive Services are covered, but the annual physical exam, health education, in-home safety assessment, personal emergency response system, 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 benefit, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. In-home support services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit are covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription Hearing Aids are covered with a maximum benefit of $1200 per year, while OTC hearing aids are also covered.
Vision Services See details
The Premier Care (HMO-POS I-SNP) plan covers vision services, including eye exams with 20% coinsurance. Eyewear is covered with 20% coinsurance, up to a combined maximum of $150 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Premier Care (HMO-POS I-SNP) plan covers dental services with a 20% coinsurance for Medicare Dental Services, and other dental services have a maximum benefit of $3,000 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments have visit limits, and some services, like Maxillofacial Prosthetics and Orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, including Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs, and Medicare Part B Insulin Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Premier Care (HMO-POS I-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Premier Care (HMO-POS I-SNP) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, and Therapeutic Radiological Services have a coinsurance of at most 20%, while Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by Premier Care (HMO-POS I-SNP) with no copay and no 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 Premier Care (HMO-POS I-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and there is no copay.
Other Services See details
The Premier Care (HMO-POS I-SNP) plan covers Over-the-Counter (OTC) Items, including Nicotine Replacement Therapy (NRT) and Naloxone, and does not require prior authorization or a referral for these services, but acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, 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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