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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 2026, 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) Washington (partial). This plan received an overall rating of 4 out of 5 stars in 2026.
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 $65.00. 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 $6000.00 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 Plus Health Plan (HMO I-SNP) features an annual prescription drug deductible of $300. Under this plan, Tier 1 preferred generic drugs are covered with no copay for a one-month, two-month, or three-month supply at standard pharmacies and through standard mail order. Tier 2 generic drugs require a $15 copay for a one-month supply, $30 for a two-month supply, and $45 for a three-month supply. For Tier 3 preferred brand drugs, you will pay a copay of $45 for a one-month supply and up to $135 for a three-month supply. Tier 4 non-preferred drugs carry a $95 copay for a one-month supply, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply. These standard pharmacy and standard mail-order rates allow you to easily estimate your out-of-pocket prescription costs.
Additional Benefits
The AgeRight Advantage Plus Health Plan (HMO I-SNP) offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care, physical therapy, home health, and skilled nursing facility stays. For inpatient hospital care, members pay a $325 copay per day for the first seven days and no copay for days eight through 90. Emergency room visits require a $90 copay, while ground ambulance services carry a $250 copay, with no coinsurance applied to either service. Specialist visits require a $20 copay, whereas diagnostic services, medical equipment, and dialysis are subject to a 20% coinsurance with no copay. Supplemental benefits include up to $1,000 annually for dental care and up to $300 annually for eyewear with no copay or coinsurance. Members also benefit from up to 32 one-way transportation trips to plan-approved locations and over-the-counter items with no copay.
Inpatient Hospital See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and some services, such as additional days, upgrades, and non-Medicare-covered stays, are not covered.
Outpatient Services See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) covers outpatient services with a 20% coinsurance, featuring no copay for ambulatory surgical center, outpatient substance abuse, and blood services. Outpatient hospital services require a copay ranging from $0 to $225 along with 20% coinsurance, while observation services have a $100 copay per stay and 20% coinsurance, with prior authorization required for most of these care options.
Partial Hospitalization See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 32 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the AgeRight Advantage Plus Health Plan (HMO I-SNP) are covered with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with a 20% coinsurance (up to $50 per visit) and no copay, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) covers primary care, occupational therapy, physical therapy, and podiatry with no copay and no coinsurance. Specialist and mental health visits require a $20 copay and no coinsurance, while psychiatric care has no copay and 20% coinsurance. Chiropractic services are partially covered, with routine care requiring a $25 copay and 20% coinsurance for up to 12 visits yearly, whereas other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by the AgeRight Advantage Plus Health Plan (HMO I-SNP) with no copay and no coinsurance for covered benefits like Medicare-covered preventive care, kidney disease education, glaucoma screenings, and memory fitness. However, several services are not covered under this plan, including annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) offers partially covered hearing services, featuring hearing exams with no copay and a 20% coinsurance for one routine exam annually. Prescription hearing aids are covered with no copay or coinsurance up to a $1,600 maximum every two years, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by AgeRight Advantage Plus Health Plan (HMO I-SNP), which offers one routine eye exam per year with no copay and a 20% coinsurance, while other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a combined maximum of $300 annually for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by the AgeRight Advantage Plus Health Plan (HMO I-SNP), which offers Medicare-covered dental with no copay and a 20% coinsurance, and other covered dental benefits with no copay and no coinsurance up to a $1,000 annual maximum. However, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
AgeRight Advantage Plus Health Plan (HMO I-SNP) partially covers Medical Equipment, as diabetic supplies are not covered under this plan. For all covered items—including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts—members will pay no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP), as lab services are not covered. Covered diagnostic procedures, radiological services, and outpatient X-rays require prior authorization and have no copay, but are subject to a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the AgeRight Advantage Plus Health Plan (HMO I-SNP) since none of the sub-services, including intensive cardiac, pulmonary, and SET for PAD, are covered in practice. These services require prior authorization, a 20% coinsurance, and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by AgeRight Advantage Plus Health Plan (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the AgeRight Advantage Plus Health Plan (HMO I-SNP), featuring acupuncture for a $25 copay and no coinsurance for up to 12 treatments yearly, alongside over-the-counter items with no copay and no coinsurance. Meal benefits, nicotine replacement therapy, and naloxone are not covered.
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