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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 2025, 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). This plan received an overall rating of 4 out of 5 stars in 2025.
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 $26.20. 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 $590.00 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 $7000.00 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) has a $590 deductible for prescription drugs. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, also known as LIS or "Extra Help", your premium is reduced to $26.20. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The AgeRight Advantage Health Plan (HMO I-SNP) offers a variety of benefits, including coverage for inpatient and outpatient services, with varying cost-sharing. Emergency services have a $90 copay, while other services like primary care, vision, dental, and medical equipment have coinsurance requirements. Additional benefits of this plan include hearing and vision services, with coverage for hearing aids and eyewear. Home health services are covered with no copay, and transportation services are provided for health-related appointments.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the AgeRight Advantage Health Plan (HMO I-SNP), but the cost sharing details (coinsurance and deductible) are not provided. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Hospital Services are covered with a 20% coinsurance, and Observation Services have a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered, but the coinsurance details are not specified. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the AgeRight Advantage Health Plan (HMO I-SNP) with prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
The AgeRight Advantage Health Plan (HMO I-SNP) covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services to plan-approved health-related locations for up to 32 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the AgeRight Advantage Health Plan (HMO I-SNP) with a $90 copay, and no coinsurance; Urgently Needed Services are covered with 20% coinsurance and no copay; however, Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The AgeRight Advantage Health Plan (HMO I-SNP) covers primary care physician services, chiropractic services with 20% coinsurance, occupational therapy services with 20% coinsurance, physician specialist services with a $30 copay, mental health specialty services with 20% coinsurance, podiatry services with 20% coinsurance, other health care professional services with 20% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits with a $0 - $30 copay and 0% - 20% coinsurance, and opioid treatment program services. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services are covered, and glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no coinsurance. Prescription Hearing Aids (all types) are covered, and have a plan maximum benefit of $1800 every two years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, routine eye exams (1 every year), eyewear with a combined maximum of $300 per year, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The AgeRight Advantage Health Plan (HMO I-SNP) provides dental services with 20% coinsurance for Medicare dental services, and other dental services are covered up to a $700 annual maximum. Oral exams are limited to 2 visits per year, and dental x-rays are limited to 2 per year. Fluoride treatments are limited to once every six months. Orthodontic services and other specific dental services are covered, but some services such as Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the AgeRight Advantage Health Plan (HMO I-SNP). Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, 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 under the AgeRight Advantage Health Plan (HMO I-SNP). The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the AgeRight Advantage Health Plan (HMO I-SNP). Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the AgeRight Advantage Health Plan (HMO I-SNP) with no copay and no coinsurance, but prior authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of 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. Prior authorization is required, and there is coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan follows Medicare-defined cost sharing for tier 1, with coinsurance details available, and additional days beyond Medicare coverage and non-Medicare covered stays are not covered.
Other Services See details
Other Services are not covered by the AgeRight Advantage Health Plan (HMO I-SNP), including acupuncture, over-the-counter (OTC) items, meal benefits, and many other sub-services. This plan does not require authorization or a referral for any additional services.
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