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Passport Advantage (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Passport Advantage (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Passport Advantage (HMO D-SNP) in 2025, please refer to our full plan details page.
Passport Advantage (HMO D-SNP) is a HMO D-SNP plan offered by Molina Healthcare, Inc. available for enrollment in 2025 to people living in Select counties in KY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Passport Advantage (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Passport Advantage (HMO D-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 Passport Advantage (HMO D-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 Passport Advantage (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.60. 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 $590.00 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 $9350.00 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 Passport Advantage (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). Those with LIS will pay $26.60 per month for Part D. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Passport Advantage (HMO D-SNP) plan offers a variety of benefits with cost-sharing. Many services, including primary care, outpatient services, and vision services, have a 20% coinsurance. Some services, such as preventive services like an annual physical exam, have no copay. The plan also covers a range of services, including emergency services, hearing aids, dental services, and medical equipment. Home health services have no copay, while inpatient hospital services, skilled nursing facilities, and home infusion services are covered with prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, but the cost sharing details for each are not provided. Additional days, non-Medicare-covered stays, and upgrades for both Acute and Psychiatric inpatient hospital services are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center services and Outpatient Substance Abuse services have a coinsurance between 20% and 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Passport Advantage (HMO D-SNP) plan. This benefit requires prior authorization and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are covered, and the plan covers rideshares, buses, subways, vans, and other medical transport options.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Passport Advantage (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a maximum plan benefit coverage of $10,000, and the coinsurance for emergency services is waived if admitted to the hospital within 24 hours.
Primary Care See details
The Passport Advantage (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy/speech-language pathology services have a 20% coinsurance. Occupational therapy services, individual and group mental health and psychiatric sessions, and opioid treatment program services have a 20% coinsurance.
Preventive Services See details
The Passport Advantage (HMO D-SNP) plan covers preventive services, including an annual physical exam, with no copay. Other preventive services, such as Glaucoma Screening, have a 20% coinsurance. Additionally, the plan covers Health Education, Nutritional/Dietary Benefit (12 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling (8 visits), Fitness Benefit, Remote Access Technologies, and Kidney Disease Education Services, with coinsurance of 20% for some services. Some services, such as In-Home Safety Assessment, are not covered.
Hearing Services See details
Hearing services include routine hearing exams, with a coinsurance of at most 20%, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered, and inner ear, outer ear, and over the ear hearing aids not covered. Over-the-counter hearing aids are also covered.
Vision Services See details
Vision Services include eye exams and eyewear coverage. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses, lenses, frames, and upgrades, also has a 20% coinsurance, and contact lenses have unlimited coverage. There is a combined maximum plan benefit coverage of $200 per year for all eyewear.
Dental Services See details
The Passport Advantage (HMO D-SNP) plan covers Medicare Dental Services with 20% coinsurance. Other dental services include oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), and orthodontic services with a $1,600 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Passport Advantage (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, are covered by the Passport Advantage (HMO D-SNP) plan. Durable medical equipment has a 20% coinsurance and requires prior authorization. Prosthetic devices and diabetic supplies also have a 20% coinsurance, while medical supplies have a 20% coinsurance as well.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. There is no copay, and you may have to pay up to 20% coinsurance for each service.
Home Health Services See details
Home Health Services are covered by the Passport Advantage (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Passport Advantage (HMO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan charges the Medicare-defined cost share for tier 1, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Passport Advantage (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits, but does not cover Acupuncture or Dual Eligible SNPs with Highly Integrated Services. The plan's OTC benefit includes Nicotine Replacement Therapy (NRT) and Naloxone coverage, and the Meal Benefit requires prior authorization. Other Services, including 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.
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