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 2025, 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 2025.
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 $185.00 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) plan has a $185 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a standard pharmacy, and 30% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The eternalHealth Forever (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that range from $0 to $325. Emergency services and ambulance services have a $100 and $300 copay, respectively. This plan provides coverage for a variety of services, including primary care, preventive services, hearing, vision, dental, and home health services. Many services have a copay, such as hearing exams ($15) and routine vision exams ($15). Medical equipment and dialysis services have a coinsurance, while some services like outpatient blood services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you'll pay a $300 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $325, Observation Services with a $325 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services has a $20 copay for both individual and group sessions, and Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the eternalHealth Forever (HMO) plan, with a copay of $25.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a $300 copay, and transportation services to plan-approved health-related locations, with no copay or coinsurance. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the eternalHealth Forever (HMO) plan. Emergency Services have a $100 copay, and Urgent Needed Services have a copay between $0 and $25; Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a copay between $0 and $25, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The eternalHealth Forever (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, and Occupational Therapy Services have a $20 copay, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. For Individual and Group Sessions for Mental Health and Psychiatric Services there is a copay between $0 and $25. For Opioid Treatment Program Services, there is a $25 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and other preventive services. This plan also covers Personal Emergency Response Systems, In-Home Support Services, and Fitness Benefits, but does not cover Health Education, In-Home Safety Assessments, 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, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams with a $15 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $595 and $895, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered. Routine hearing exams are limited to 1 per year, and prescription hearing aids are limited to 2 per year.
Vision Services See details
The eternalHealth Forever (HMO) plan covers vision services, including routine eye exams with a $15 copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames; however, upgrades are not covered. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The eternalHealth Forever (HMO) plan covers dental services, including Medicare dental services with a $45 copay, and other dental services with a $3,000 maximum benefit per year. Additional services like oral exams, dental x-rays, and orthodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the eternalHealth Forever (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the eternalHealth Forever (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a 20% coinsurance, and requires prior authorization. For prosthetics and medical supplies, there is a 20% coinsurance. 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 under the eternalHealth Forever (HMO) plan, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $100 and up to $250, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the eternalHealth Forever (HMO) plan 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 technically covered, but not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the eternalHealth Forever (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and a Meal Benefit, but does not cover Acupuncture, 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. The OTC benefit provides up to $60 every three months for items, including nicotine replacement therapy and naloxone.
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