A non-government entity
eternalHealth Forever (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for eternalHealth Forever (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on eternalHealth Forever (HMO) in 2026, please refer to our full plan details page.
eternalHealth Forever (HMO) is a HMO plan offered by Eternal Health of Delaware, Inc. available for enrollment in 2025 to people living in Bris, Middle, Nor, Ply, Suff & Wor. The overall rating for this plan is not yet available for 2026.
It's important to know that eternalHealth Forever (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 eternalHealth Forever (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 eternalHealth Forever (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 $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 Maximum Out-Of-Pocket cost of $5000.00 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 eternalHealth Forever (HMO) prescription drug plan has an annual drug deductible of $250. You will pay no copay for Tier 1 Preferred Generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 Generic drugs, copays range from $5 for a 1-month supply to $15 for a 3-month standard pharmacy supply, while a 3-month standard mail order supply costs $10. Higher-tier medications under this plan require coinsurance instead of flat copayments. You can expect a 23% coinsurance for Tier 3 Preferred Brand drugs and a 40% coinsurance for Tier 4 Non-Preferred drugs. Tier 5 Specialty Tier drugs require a 30% coinsurance for a 1-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The eternalHealth Forever (HMO) plan offers robust coverage with no copay for primary care, specialist visits, telehealth, and annual preventive screenings. For inpatient hospital stays, members pay a $300 daily copay for days one through five, followed by no copay for days six through ninety. Emergency room visits require a $125 copay, which is waived if you are admitted to the hospital within 24 hours. Extra benefits include comprehensive dental services with no copay up to a $2,500 annual maximum, alongside a $200 annual allowance for eyewear with no copay. Routine hearing and vision exams are available for a $25 copay, while prescription hearing aids require copays between $595 and $895. Members also benefit from up to 36 free one-way transportation trips to plan-approved locations and a $60 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
eternalHealth Forever (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 copay per day for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
eternalHealth Forever (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copays. Outpatient hospital services have copays ranging from $0 to $325, while observation services require a $325 copay per stay and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by eternalHealth Forever (HMO) with a $25.00 copay and no coinsurance.
Ambulance and Transportation Services See details
eternalHealth Forever (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance per service. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
eternalHealth Forever (HMO) covers emergency services with a $125 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed and worldwide emergency services are also covered with no coinsurance, featuring copays ranging from no copay up to $300 and a $25,000 maximum limit for worldwide coverage.
Primary Care See details
eternalHealth Forever (HMO) provides primary care, specialist visits, and telehealth services with no copay and no coinsurance, while physical, occupational, and speech therapies require a $30 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have copays up to $25 with no coinsurance, podiatry is not covered, and some chiropractic services are covered with a $15 copay and no coinsurance but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by eternalHealth Forever (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, additional smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, or counseling.
Hearing Services See details
eternalHealth Forever (HMO) covers hearing services with no deductible, including annual routine hearing exams for a $25 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $595 to $895 for up to two devices per year, but over-the-counter (OTC) models and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
eternalHealth Forever (HMO) covers one routine eye exam per year with a $25 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $200 annual limit, but upgrades are not covered.
Dental Services See details
eternalHealth Forever (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance. Other preventive and comprehensive dental services, including exams, cleanings, implants, and orthodontics, are covered with no copay and no coinsurance up to a $2,500 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by eternalHealth Forever (HMO) with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance of 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
eternalHealth Forever (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
eternalHealth Forever (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and a required prior authorization. A 20% coinsurance applies to most equipment, medical supplies, and therapeutic shoes, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by eternalHealth Forever (HMO) with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient x-rays have a $10 copay, diagnostic tests range from no copay to $10, and diagnostic and therapeutic radiological services have minimum copays of $100 and $60.
Home Health Services See details
Home Health Services are covered by eternalHealth Forever (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by eternalHealth Forever (HMO), with only additional cardiac rehabilitation services covered for a $25 copay and no coinsurance. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
eternalHealth Forever (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20, a $203 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
eternalHealth Forever (HMO) provides coverage for select other services, including a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit offers up to $60 every three months via reimbursement, though acupuncture is not covered under this plan.
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