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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 2026, 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 2026.
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 $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 Premier Health Plan (HMO C-SNP) prescription drug coverage includes an annual drug deductible of $300. Beneficiaries will enjoy no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order. Tier 2 generic drugs are available at standard pharmacies and standard mail order for 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, standard copays are $45 for a one-month supply, $90 for a two-month supply, and $135 for a three-month supply. Tier 4 non-preferred drugs require standard copays of $95 for one month, $190 for two months, and $285 for three months. Lastly, Tier 5 specialty drugs incur a 29% coinsurance for a one-month supply through standard retail pharmacies or standard mail order.
Additional Benefits
The AgeRight Advantage Premier Health Plan (HMO C-SNP) offers affordable access to essential medical care, featuring no copay and no coinsurance for primary care, home health, and skilled nursing facility services. For inpatient hospital stays, members pay a $325 daily copay for the first seven days and no copay for days eight through 90. Specialist visits require a copay of up to $20, while outpatient hospital services range from no copay to a $225 copay and 20% coinsurance. This plan also includes valuable supplemental benefits such as routine dental care up to a $1,000 annual limit and annual vision exams with a $330 eyewear allowance, both with no copay and no coinsurance. Additionally, members receive hearing aid coverage up to a $1,600 maximum benefit every two years and up to 30 one-way transportation trips per year with no copay or coinsurance. Over-the-counter items are also covered with no copay and no coinsurance to help manage everyday health needs.
Inpatient Hospital See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 to 7 and no copay for days 8 to 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers outpatient services, featuring outpatient hospital care with a copay ranging from no copay to $225 and 20% coinsurance. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are covered with no copay and 20% coinsurance. Medicare-covered observation services are also covered with a $100 copay per stay plus coinsurance, with prior authorization required for most outpatient benefits.
Partial Hospitalization See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by AgeRight Advantage Premier Health Plan (HMO C-SNP), with ground ambulance services requiring a $250 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Plan-approved transportation is partially covered with no copay and no coinsurance for up to 30 one-way trips per year, though transportation to any health-related location is not covered.
Emergency Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $50) and no copay, with costs waived if admitted 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
Primary care, therapy, podiatry, and opioid treatment services are covered with no copay and no coinsurance under the AgeRight Advantage Premier Health Plan (HMO C-SNP). Specialist, telehealth, and mental health services require copays up to $20 with no coinsurance, whereas psychiatric and other professional services have no copay and a 20% coinsurance. Chiropractic services are partially covered, with routine care requiring a $25 copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) provides coverage for Medicare-covered preventive services, kidney disease education, and select other preventive services with no copay and no coinsurance. Preventive services are partially covered under this plan, as the annual physical exam and most additional benefits—such as health education, in-home safety assessments, and personal emergency response systems—are not covered, though a memory fitness benefit is included.
Hearing Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers hearing exams with no copay and a 20% coinsurance for routine annual exams, with no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,600 maximum benefit every two years, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are partially covered by AgeRight Advantage Premier Health Plan (HMO C-SNP) with no copay and no coinsurance, providing one routine eye exam per year and a $330 annual maximum benefit for eyewear. Covered eyewear includes contact lenses, eyeglasses, frames, lenses, and upgrades, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by the AgeRight Advantage Premier Health Plan (HMO C-SNP), featuring Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $1,000 annual limit. However, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance to 20% coinsurance, with insulin drugs also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the AgeRight Advantage Premier Health Plan (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) partially covers diagnostic and radiological services, which require prior authorization. Covered services—including diagnostic procedures, therapeutic and diagnostic 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 Premier Health Plan (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
AgeRight Advantage Premier Health Plan (HMO C-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by AgeRight Advantage Premier Health Plan (HMO C-SNP) with no copay, although prior authorization is required. Admission is allowed without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the AgeRight Advantage Premier Health Plan (HMO C-SNP) are partially covered, featuring acupuncture with a $25 copay and no coinsurance for up to 12 treatments per year, and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits, nicotine replacement therapy, and naloxone are not covered under these services.
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