A non-government entity
AgeRight Advantage Plus Health Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AgeRight Advantage Plus 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 Plus Health Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
AgeRight Advantage Plus 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 Plus 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 Plus 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 Plus 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 Plus Health Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.00. 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 $300.00 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:
Sign up for AgeRight Advantage Plus Health Plan (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The AgeRight Advantage Plus Health Plan (HMO I-SNP) has a $300 deductible for prescription drugs. Once you meet your deductible, your cost will vary depending on the drug tier and the pharmacy you use. For preferred and standard pharmacies, you will pay a copay for generic and brand name drugs. Non-preferred drugs will have a 29% coinsurance, and specialty drugs are not covered in this plan.
Additional Benefits
The AgeRight Advantage Plus Health Plan (HMO I-SNP) offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, partial hospitalization, and ambulance services have copays or coinsurance. The plan also covers primary care, preventive services, hearing, vision, dental, and home infusion services. This plan includes coverage for diagnostic and radiological services, home health services, and skilled nursing facilities, with some services requiring prior authorization or having coinsurance. Additionally, the plan provides coverage for acupuncture and over-the-counter items, but excludes some services like cardiac rehabilitation and certain home-based care options.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but require prior authorization. For days 1-7, there is a $325 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a 20% coinsurance and a copay between $0 and $225, and Observation Services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance of 20%, but Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP), with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $250 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP) with a $90 copay and no coinsurance. Urgently Needed Services have a 20% coinsurance with no copay, while Worldwide Emergency Services are not covered.
Primary Care See details
The AgeRight Advantage Plus Health Plan (HMO I-SNP) covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a 20% coinsurance and routine chiropractic care has a $25 copay for 12 visits per year. Physician specialist services have a $20 copay, while individual and group mental health sessions have a $20 copay. Routine foot care has a 20% coinsurance and additional telehealth benefits have a copay between $0 and $20.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs after a Welcome Visit. However, the plan does not cover 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, or Counseling Services.
Hearing Services See details
Hearing services include coverage for hearing exams with a coinsurance of at most 20% and routine hearing exams (1 per year) and fitting/evaluation for hearing aids. The plan provides up to $1600 every two years for prescription hearing aids (all types), but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, routine eye exams once per year, and eyewear with a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The AgeRight Advantage Plus Health Plan (HMO I-SNP) offers dental services with 20% coinsurance for Medicare dental services, and a $1,000 annual maximum for other dental services. Oral exams and dental x-rays are covered with limitations on the number of visits, while fluoride treatment is limited to once every six months. Orthodontics is not covered, and some services like maxillofacial prosthetics and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the AgeRight Advantage Plus Health Plan (HMO I-SNP) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. Durable Medical Equipment has a 20% coinsurance, and 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 Plus 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 Medicare-covered lab services have no copay.
Home Health Services See details
Home Health Services are covered by the AgeRight Advantage Plus Health Plan (HMO I-SNP) with no copay or 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 AgeRight Advantage Plus Health Plan (HMO I-SNP). Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and coinsurance applies; however, further details about the coinsurance are not provided.
Other Services See details
Other Services includes acupuncture, which has a $25 copay for up to 12 treatments per year, and over-the-counter (OTC) items, which are covered with a maximum benefit of $300 every three months. Meal Benefit, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved