A non-government entity
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 JoDaviess County. 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) offers comprehensive coverage with no copay for many services, including ambulance, emergency, and primary care services. The plan also covers vision services, including one routine eye exam annually, and dental services. This plan has some limitations on coverage. It does not cover hearing services or skilled nursing facilities. Additionally, some services, like outpatient substance abuse and cardiac rehabilitation, are only partially covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Medical Associates SmartPlan (Cost). Some services, including additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, but outpatient substance abuse services are only partially covered, as individual and group sessions are not covered. Outpatient blood services include an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the Medical Associates SmartPlan (Cost). There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Medical Associates SmartPlan (Cost). All Ambulance Services are covered with no copay and no coinsurance, but Ground Ambulance Services and Air Ambulance Services are not covered. Transportation Services, including those to plan-approved or any health-related locations, are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Medical Associates SmartPlan (Cost), with no copay and no coinsurance. Worldwide Emergency Services includes services not usually covered by Medicare plans.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy, Speech-Language Pathology Services, Opioid Treatment Program Services, and Podiatry Services are covered with no copay and no coinsurance. Chiropractic Services, Mental Health Specialty Services, Psychiatric Services, and Additional Telehealth Benefits are partially covered, with Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Additional Telehealth Benefits not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar preventive services and annual physical exams. Additional preventive services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services. Kidney Disease Education Services and other preventive services, like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are also covered.
Hearing Services See details
Hearing services are not covered by the Medical Associates SmartPlan (Cost). 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 one routine eye exam every year with no copay. Eyewear is also covered, 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 by the Medical Associates SmartPlan (Cost), but 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. The plan does cover Medicare Dental Services, but does not provide further information on copays or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are not covered by the Medical Associates SmartPlan (Cost).
Dialysis Services See details
Dialysis Services are covered with no copay and no coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefits with no copay or coinsurance. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are generally 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 covered services.
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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered under the Medical Associates SmartPlan (Cost).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are not covered by the Medical Associates SmartPlan (Cost).
Other Services See details
The Medical Associates SmartPlan (Cost) does not cover acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and other services. This plan does not require authorization or a referral for additional services.
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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