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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 2026, 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 2026.
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 $29.40. 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 $615.00 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 $9250.00 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) prescription drug plan features an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs filled at standard pharmacies or through standard mail order. This ensures that many common and essential medications are available to members at no cost. For other drug tiers, cost-sharing is based on coinsurance for standard pharmacy and standard mail order fills. You will pay a 20% coinsurance for Tier 2 generic and Tier 3 preferred brand drugs, 30% coinsurance for Tier 4 non-preferred drugs, and 25% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Passport Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copays for the vast majority of its services, though coinsurance applies to several benefits. Members enjoy fully covered inpatient hospital stays, home health care, and skilled nursing facility services with no copay and no coinsurance. However, outpatient care, primary and specialist visits, diagnostic tests, and durable medical equipment typically require a 20% to 30% coinsurance. In addition to core medical care, this plan provides valuable supplemental benefits including dental, vision, hearing, and transportation services with no copays. Routine preventive and comprehensive dental care, OTC hearing aids, and unlimited transportation to approved locations are available with no coinsurance. Other services, such as routine eye exams, hearing exams, and dialysis, are subject to a 20% coinsurance.
Inpatient Hospital See details
Passport Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Passport Advantage (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Passport Advantage (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Passport Advantage (HMO D-SNP) covers ambulance and transportation services, though transportation is only partially covered because rides to non-plan-approved locations are excluded. Ground and air ambulance services require prior authorization and have a 20% coinsurance with no copay, while unlimited one-way trips to plan-approved locations are provided with no copay and no coinsurance.
Emergency Services See details
Passport Advantage (HMO D-SNP) covers emergency services with a 30% coinsurance and no copay, up to a maximum of $115 per visit, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 30% coinsurance and no copay up to a maximum of $40 per visit, while worldwide emergency services are covered up to $10,000 with no copay and no coinsurance.
Primary Care See details
Passport Advantage (HMO D-SNP) primary care and specialist benefits are partially covered with no copay and a 20% to 30% coinsurance. Covered services include physical therapy, occupational therapy, and routine chiropractic care up to 20 visits per year, while podiatry and non-routine chiropractic services are not covered.
Preventive Services See details
Passport Advantage (HMO D-SNP) covers preventive services, including annual physical exams and select additional services with no copay and no coinsurance, while kidney disease education and other screenings have no copay and a 20% coinsurance. This benefit is partially covered, as it excludes in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Passport Advantage (HMO D-SNP) covers annual routine hearing exams and fittings with no copay and a 20% coinsurance, alongside unlimited OTC hearing aids with no copay and no coinsurance. For prescription hearing aids, some services are covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Passport Advantage (HMO D-SNP) covers vision services with no copays, although a 20% coinsurance applies to routine eye exams and contact lenses. The plan provides one routine eye exam per year and up to a $200 annual maximum for eyewear, while other eye exam services are not covered.
Dental Services See details
Passport Advantage (HMO D-SNP) partially covers dental services, offering Medicare-covered dental services with no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services require no copay and no coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Passport Advantage (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and between no coinsurance and 20% coinsurance, while Part B insulin drugs have a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Passport Advantage (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Passport Advantage (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage is subject to preferred vendor and manufacturer limitations.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Passport Advantage (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes Medicare-covered diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered under Passport Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Passport Advantage (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, subject to prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Passport Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Passport Advantage (HMO D-SNP) partially covers other services, which includes over-the-counter (OTC) items and limited-duration meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan, and prior authorization is required for the meal benefit.
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