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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 JoDaviess County. 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) offers robust coverage for essential medical services, highlighting a cost structure with no copay and no coinsurance for most covered benefits. Members can access inpatient and outpatient hospital care, emergency services, primary care, and specialist visits with zero out-of-pocket cost-sharing. Additionally, key services like home health, dialysis, and preventive care are covered with no copay. However, the plan has limited coverage for routine ancillary benefits and prescription drugs. Routine dental care, hearing aids, eyewear, and fitness programs are excluded, and there is no coverage for Medicare Part B drugs. This plan is highly beneficial for those prioritizing affordable core medical and emergency coverage, but individuals should plan for out-of-pocket expenses for routine vision, dental, and hearing needs.
Inpatient Hospital See details
Medical Associates SmartPlan (Cost) partially covers inpatient hospital services, offering acute and psychiatric care with no copay and no coinsurance. However, additional days and non-Medicare-covered stays are not covered for either service, and upgrades are not covered for acute stays.
Outpatient Services See details
Medical Associates SmartPlan (Cost) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. For outpatient substance abuse, some services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Medical Associates SmartPlan (Cost) covers partial hospitalization services 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. While the plan indicates some services are covered, ground ambulance, air ambulance, and health-related transportation services are not covered in practice.
Emergency Services See details
Emergency services, urgently needed services, and worldwide emergency coverage—including emergency transportation—are fully covered by the Medical Associates SmartPlan (Cost) with no copay and no coinsurance.
Primary Care See details
Primary care benefits under the Medical Associates SmartPlan (Cost) are covered with no copay and no coinsurance, including primary care provider, specialist, and therapy services. Some services are covered for chiropractic, mental health, and psychiatric care, but routine chiropractic care, individual and group sessions, and telehealth are not covered.
Preventive Services See details
Medical Associates SmartPlan (Cost) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. While some additional preventive services are covered, specific programs such as fitness benefits, health education, and medical nutrition therapy are not covered.
Hearing Services See details
Medical Associates SmartPlan (Cost) partially covers hearing exams with no copay and no coinsurance, excluding routine hearing exams and fitting evaluations. While some prescription hearing aid services are covered, all specific types—including inner ear, outer ear, over the ear, and OTC hearing aids—are not covered.
Vision Services See details
Medical Associates SmartPlan (Cost) offers partially covered vision services, which include one routine eye exam per year with no copay, no coinsurance, and no deductible, while other eye exam services are excluded. Eyewear is technically covered with no copay or coinsurance, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered in practice.
Dental Services See details
Medical Associates SmartPlan (Cost) partially covers dental services, offering Medicare-covered dental care with no copay and no coinsurance. Routine and comprehensive services—including oral exams, cleanings, x-rays, fluoride, restorative care, endodontics, periodontics, prosthodontics, and implants—are not covered.
Home Infusion bundled Services See details
Medical Associates SmartPlan (Cost) does not cover Home Infusion bundled services, although insulin is covered. Medicare Part B insulin drugs, chemotherapy and radiation drugs, and other Part B drugs are not covered under this plan.
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) partially covers medical equipment, providing durable medical equipment (DME) with no copay and no coinsurance. Under this plan, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Medical Associates SmartPlan (Cost) with no copay and no coinsurance. While some services are covered, diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays are not covered.
Home Health Services See details
Home health services are covered under the Medical Associates SmartPlan (Cost), offering patients necessary in-home care with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medical Associates SmartPlan (Cost) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Medical Associates SmartPlan (Cost) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though a prior three-day inpatient hospital stay is required. Additional days beyond the standard Medicare-covered limit are not covered.
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 all excluded from coverage.
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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