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Medical Associates SmartPlan (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medical Associates SmartPlan (Cost). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medical Associates SmartPlan (Cost) in 2025, please refer to our full plan details page.
Medical Associates SmartPlan (Cost) is a Cost plan offered by Medical Associates Clinic, P.C. available for enrollment in 2025 to people living in Dubuque, Clayton, Delaware, Jackson,Jones Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Medical Associates SmartPlan (Cost) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Medical Associates SmartPlan (Cost).
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 Medical Associates SmartPlan (Cost), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below for more information.
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 Medical Associates SmartPlan (Cost)
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
Prescription drugs are not covered by Medical Associates SmartPlan (Cost).
Additional Benefits
The Medical Associates SmartPlan (Cost) plan offers a range of benefits with varying cost structures. Many services, such as primary care, emergency services, and home health, have no copay. The plan covers preventive services like annual physical exams and certain screenings, but excludes health education and fitness benefits. While the plan covers some outpatient and vision services, it has limitations on hearing, dental, and skilled nursing facility services. Diagnostic and radiological services are covered with no copay, but other services like home infusion and cardiac rehabilitation have limited coverage.
Inpatient Hospital See details
Inpatient Hospital coverage is provided under the Medical Associates SmartPlan (Cost) plan. However, additional days for inpatient hospital-acute, non-Medicare-covered stays for inpatient hospital-acute, upgrades for inpatient hospital-acute, and additional days for inpatient hospital psychiatric, and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Medical Associates SmartPlan (Cost).
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Medical Associates SmartPlan (Cost). All ambulance services are covered with no copay and no coinsurance, while ground and air ambulance services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medical Associates SmartPlan (Cost). There is no copay or coinsurance for Emergency Services and Urgently Needed Services, but Worldwide Emergency Services has a $250 deductible and a 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are covered with no copay and no coinsurance. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services are partially covered, and Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are not covered. Podiatry Services are covered, including Routine Foot Care for 6 visits per year. Additional Telehealth Benefits are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, a fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services are not covered by the Medical Associates SmartPlan (Cost) as hearing exams, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Medical Associates SmartPlan (Cost) covers vision services including routine eye exams once per year with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered under the Medical Associates SmartPlan (Cost). While Medicare Dental Services are covered, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are not covered by this plan.
Dialysis Services See details
Dialysis Services are covered with this plan. There is no specific cost information provided for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), which has no copay or coinsurance, but does not include Durable Medical Equipment for use outside the home. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with no copay or coinsurance, but Prosthetic Devices and Medical Supplies are not covered. Diabetic Equipment benefits are covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medical Associates SmartPlan (Cost), but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the services that are covered.
Home Health Services See details
Home Health Services are covered by the Medical Associates SmartPlan (Cost), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are not covered by the Medical Associates SmartPlan (Cost).
Other Services See details
Other Services are not covered by the Medical Associates SmartPlan (Cost). Specifically, acupuncture, over-the-counter items, meal benefits, 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
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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.
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