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AgeRight Advantage Premier Health Plan (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AgeRight Advantage Premier Health Plan (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AgeRight Advantage Premier Health Plan (HMO C-SNP) in 2025, please refer to our full plan details page.
AgeRight Advantage Premier Health Plan (HMO C-SNP) is a HMO C-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 Premier Health Plan (HMO C-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 Premier Health Plan (HMO C-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 Premier Health Plan (HMO C-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 Premier Health Plan (HMO C-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:
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Drug Coverage
The AgeRight Advantage Premier Health Plan (HMO C-SNP) has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay $15 for preferred generic drugs at a standard or mail-order pharmacy. For non-preferred drugs, you'll pay 29% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your covered drugs.
Additional Benefits
The AgeRight Advantage Premier Health Plan (HMO C-SNP) offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $325 copay for the first 7 days, while outpatient services have a coinsurance or copay depending on the service. You'll also have access to a variety of services with copays or coinsurance, including primary care, hearing, vision, and dental. This plan provides coverage for ambulance services, emergency services, and home health services. The plan also covers certain prescription drugs, diagnostic services, and medical equipment with coinsurance. Be aware that some services, such as cardiac rehabilitation and certain dental and vision services, may have limitations or are not covered at all.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric services. For days 1-7, the copay is $325, and there is no copay for days 8-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with a 20% coinsurance and a copay between $0 and $225, and observation services with a $100 copay. Ambulatory surgical center services and outpatient substance abuse services are covered, but coinsurance information is not provided. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under the AgeRight Advantage Premier Health Plan (HMO C-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services includes a $90 copay with no coinsurance. Urgently Needed Services has a 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The AgeRight Advantage Premier Health Plan (HMO C-SNP) covers Primary Care Physician Services, Chiropractic Services with 20% coinsurance for routine care, Occupational Therapy Services with no copay or coinsurance, Physician Specialist Services with a copay between $0 and $20, and Mental Health Specialty Services with a $20 copay for individual and group sessions. Podiatry Services are covered with no copay, and Other Health Care Professional services have a 20% coinsurance. Psychiatric Services have 20% coinsurance for individual and group sessions, and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance. Additional Telehealth Benefits have a copay between $0 and $20, and Opioid Treatment Program Services are covered, but require prior authorization.
Preventive Services See details
The AgeRight Advantage Premier Health Plan (HMO C-SNP) covers Medicare-covered preventive services with no copay, and additional preventive services, though some are not covered, including annual physical exams, health education, in-home safety assessments, and more. Other preventive services like glaucoma screenings, diabetes self-management training, and barium enemas are covered.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of at most 20%, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered, with a maximum benefit of $1600 every two years, but prescription hearing aids for the inner, outer, or over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include routine eye exams with one visit every year, and eyewear benefits that include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $330.00 every year.
Dental Services See details
The AgeRight Advantage Premier Health Plan (HMO C-SNP) offers dental services with 20% coinsurance for Medicare dental services, and a $1,000 annual maximum for other dental services. Oral exams are covered for 2 visits per year, and dental x-rays are covered for 2 per year, while other services like Maxillofacial Prosthetics, Implant Services, and Orthodontics 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, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for all services.
Dialysis Services See details
Dialysis Services are covered under the AgeRight Advantage Premier Health Plan (HMO C-SNP). The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies, both with 20% coinsurance, but excludes Durable Medical Equipment for use outside the home. Diabetic Equipment is covered, but Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the AgeRight Advantage Premier Health Plan (HMO C-SNP). Diagnostic procedures and tests have a coinsurance of at most 20%, while lab services are not covered. Diagnostic, therapeutic, and outpatient X-ray radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the AgeRight Advantage Premier Health Plan (HMO C-SNP), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AgeRight Advantage Premier Health Plan (HMO C-SNP). Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but require prior authorization. The plan charges the Medicare-defined cost share for tier 1, and does not charge cost sharing on the day of discharge. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under Other Services, AgeRight Advantage Premier Health Plan (HMO C-SNP) covers acupuncture with a $25 copay, up to 12 treatments per year, and over-the-counter (OTC) items with a maximum benefit of $65 per month. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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