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AgeRight Advantage Health Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AgeRight Advantage Health Plan (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AgeRight Advantage Health Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
AgeRight Advantage Health Plan (HMO I-SNP) is a HMO I-SNP plan offered by Marquis Companies I, Inc. available for enrollment in 2025 to people living in Oregon (partial) Washington (partial). This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that AgeRight Advantage Health Plan (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
AgeRight Advantage Health Plan (HMO 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 AgeRight Advantage Health Plan (HMO 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 AgeRight Advantage Health Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. 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 $615.00 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 $9250.00 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 AgeRight Advantage Health Plan (HMO I-SNP) features an annual prescription drug deductible of $615. This deductible is the amount you must pay out of pocket for your covered medications before your plan benefits kick in. Specific drug coverage tier details, including copay and coinsurance amounts for different medication categories, are currently unavailable for this plan. For the most accurate and up-to-date cost estimates for your specific prescriptions, it is recommended to review the plan's comprehensive formulary or contact the provider directly.
Additional Benefits
The AgeRight Advantage Health Plan (HMO I-SNP) offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and primary care physician visits. For outpatient care, diagnostic tests, and specialist visits, members generally pay a twenty percent coinsurance or low copayments, including a thirty dollar copay for specialists and a ninety dollar copay for emergency room visits. The plan also includes up to forty-eight one-way trips per year to approved health-related locations with no copay and no coinsurance. Supplementary benefits like dental and vision care are highly covered, offering no copay and no coinsurance up to a seven hundred dollar annual limit for dental services and a three hundred dollar annual maximum for eyewear. Additionally, hearing aids are covered up to eighteen hundred dollars every two years with no copay, and members receive a ninety dollar credit every three months for over-the-counter items with no copay or coinsurance. Durable medical equipment, home health services, and home infusions are also covered, typically requiring either no copay or a twenty percent coinsurance depending on the specific service.
Inpatient Hospital See details
AgeRight Advantage Health Plan (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to Medicare-defined deductibles and prior authorization. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services covered by the AgeRight Advantage Health Plan (HMO I-SNP) generally feature a 20% coinsurance and no copay for ambulatory surgical center, outpatient substance abuse, and blood services. Outpatient hospital services require a 20% coinsurance, while observation services incur a $100 copay per stay, with prior authorization required for most of these benefits.
Partial Hospitalization See details
Partial hospitalization is covered by the AgeRight Advantage Health Plan (HMO I-SNP) with no copay and a 20% coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
AgeRight Advantage Health Plan (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
AgeRight Advantage Health Plan (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40) and no copay, both of which count toward the deductible and are waived if admitted to the hospital within three days. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
AgeRight Advantage Health Plan (HMO I-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Other services like therapy, mental health, and podiatry feature no copay and 15% to 20% coinsurance. For chiropractic benefits, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by AgeRight Advantage Health Plan (HMO I-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar services, kidney disease education, and select screenings. However, annual physical exams and additional preventive services—such as fitness benefits, health education, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing services covered by the AgeRight Advantage Health Plan (HMO I-SNP) include hearing exams with no copay and a 20% coinsurance for routine visits. Prescription hearing aids are partially covered with no copay and no coinsurance up to $1,800 every two years, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
AgeRight Advantage Health Plan (HMO I-SNP) covers vision services, providing one routine eye exam annually with no copay and a 20% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $300 annual maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by the AgeRight Advantage Health Plan (HMO I-SNP), with Medicare-covered services requiring no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $700 annual maximum, though other preventive dental, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
AgeRight Advantage Health Plan (HMO I-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the AgeRight Advantage Health Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by the AgeRight Advantage Health Plan (HMO I-SNP), as diabetic supplies are not covered. Covered benefits, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, feature no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by AgeRight Advantage Health Plan (HMO I-SNP) and require prior authorization. Covered diagnostic procedures, radiological services, therapeutic radiological services, and outpatient X-rays have a 20% coinsurance and no copay, while lab services are not covered.
Home Health Services See details
AgeRight Advantage Health Plan (HMO I-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the AgeRight Advantage Health Plan (HMO I-SNP) require prior authorization and have no copay, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by the AgeRight Advantage Health Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for SNF admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
AgeRight Advantage Health Plan (HMO I-SNP) provides partial coverage for Other Services, which includes Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $90 every three months. However, acupuncture, meal benefits, Nicotine Replacement Therapy, and Naloxone are not covered under this plan.
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