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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 2026, 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 2026.
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) provides comprehensive coverage for core medical needs, featuring no copay and no coinsurance for inpatient and outpatient hospital stays, primary and specialist care, and home health services. Preventive care, dialysis, and durable medical equipment are also fully covered with no copays or coinsurance. However, the plan excludes many routine supplemental benefits, meaning members will not have coverage for routine dental cleanings, eyewear, hearing aids, or fitness programs. For emergency situations, domestic urgent care and emergency services are covered with no copay and no coinsurance. Worldwide emergency care is also available, though it requires a 20% coinsurance after a deductible is met up to a maximum benefit. Other exclusions to keep in mind include cardiac rehabilitation, home infusion services, and over-the-counter items, which are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Medical Associates SmartPlan (Cost), offering acute and psychiatric care with no copay and no coinsurance. However, additional hospital days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Medical Associates SmartPlan (Cost) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and outpatient blood services. Outpatient substance abuse services are not covered under this plan because both individual and group sessions are excluded.
Partial Hospitalization See details
Partial hospitalization services are covered by the Medical Associates SmartPlan (Cost) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Medical Associates SmartPlan (Cost) with no copay and no coinsurance; however, only some services are covered, and ground ambulance, air ambulance, and health-related transportation services are not covered.
Emergency Services See details
Emergency Services under the Medical Associates SmartPlan (Cost) are covered with no copay and no coinsurance for domestic emergency and urgent care. Worldwide emergency, urgent, and emergency transportation services are also covered with no copay and a 20% coinsurance after a deductible, up to a maximum plan benefit of $50,000.
Primary Care See details
Medical Associates SmartPlan (Cost) offers primary care, specialist, therapy, podiatry, and opioid treatment services with no copay and no coinsurance. Some chiropractic, mental health, and psychiatric services are covered with no copay and no coinsurance, but routine and other chiropractic care, individual and group therapy sessions, and additional telehealth benefits are not covered.
Preventive Services See details
Preventive Services under the Medical Associates SmartPlan (Cost) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. However, additional preventive services are not covered in practice, including fitness benefits, health education, weight management programs, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Medical Associates SmartPlan (Cost), offering diagnostic hearing exams with no copay and no coinsurance. Routine hearing exams, fitting and evaluation for hearing aids, prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Medical Associates SmartPlan (Cost), which offers one routine eye exam per year with no copay, no coinsurance, and no deductible. Other eye exam services and all eyewear, including contact lenses, eyeglasses, lenses, and frames, are not covered.
Dental Services See details
Medical Associates SmartPlan (Cost) partially covers dental services, offering Medicare-covered dental care with no copay and no coinsurance. However, other dental and orthodontic services—including oral exams, cleanings, x-rays, fluoride treatments, restorative care, and implants—are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are not covered by the Medical Associates SmartPlan (Cost), which excludes coverage for Medicare Part B chemotherapy, radiation, and other Part B drugs. While insulin is covered under the plan, Medicare Part B insulin drugs are specifically not covered.
Dialysis Services See details
Dialysis services are covered under the Medical Associates SmartPlan (Cost) with no copay and no coinsurance.
Medical Equipment See details
Medical Associates SmartPlan (Cost) covers Durable Medical Equipment (DME) with no copay and no coinsurance. While some other medical and diabetic equipment services are covered with no copay and no coinsurance, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered in practice.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Medical Associates SmartPlan (Cost) with no copay and no coinsurance. While some services are covered, diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Medical Associates SmartPlan (Cost) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Medical Associates SmartPlan (Cost), as the plan does not provide coverage for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medical Associates SmartPlan (Cost) with no copay and no coinsurance under Original Medicare benefit periods. A prior three-day inpatient hospital stay is required for admission, and the plan does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Other Services are not covered under the Medical Associates SmartPlan (Cost), as acupuncture, over-the-counter (OTC) items, and meal benefits are excluded from coverage. Because these services are not covered, there are no associated copays or coinsurance costs.
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.
* 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.
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Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
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