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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) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs and Tier 6 select care drugs when using standard pharmacies or standard mail order services. This zero-dollar cost-sharing applies to one-month, two-month, and three-month supplies of these medications. For other medication categories, cost-sharing is based on coinsurance percentages at standard pharmacies and standard mail order. You will pay a 20% coinsurance for Tier 2 generic and Tier 3 preferred brand drugs, and a 30% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Passport Advantage (HMO D-SNP) plan offers comprehensive medical coverage with no copays for inpatient hospital stays, primary care visits, and outpatient services. Instead of copays, members generally pay a 20% to 30% coinsurance for outpatient hospital care, specialist visits, and emergency services. Home health services and preventive care like annual physicals are fully covered with no copay and no coinsurance. For supplemental care, the plan features dental, vision, and hearing benefits with no copays, though routine eye and hearing exams require a 20% coinsurance. This plan also includes a $200 annual eyewear allowance, covered hearing aids, and unlimited one-way rides to plan-approved health locations with no copay and no coinsurance. Additionally, members can access over-the-counter items and qualifying meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Passport Advantage (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization is required. However, additional days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Passport Advantage (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Passport Advantage (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Passport Advantage (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Passport Advantage (HMO D-SNP) covers emergency services with a 30% coinsurance and no copay up to $115 per visit, which is waived if admitted to the hospital within 24 hours. Urgently needed services also carry a 30% coinsurance and no copay up to $40 per visit, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $10,000 maximum limit.
Primary Care See details
Passport Advantage (HMO D-SNP) covers primary care, specialist, therapy, mental health, and telehealth services with no copay and a 20% to 30% coinsurance. Chiropractic services are partially covered, offering up to 20 routine visits per year with no copay and 30% coinsurance, while other chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Passport Advantage (HMO D-SNP), with annual physicals, fitness benefits, and nutritional sessions covered at no copay and no coinsurance, while kidney education and glaucoma screenings require no copay and 20% coinsurance. However, several additional services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Passport Advantage (HMO D-SNP) provides hearing services with no copay for exams, though routine hearing exams carry a 20% coinsurance. Prescription hearing aids (limited to two every two years) and OTC hearing aids are covered with no copay and no coinsurance, but prescription aids are only partially covered as inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Passport Advantage (HMO D-SNP), featuring no copays or deductibles for all covered services, with a 20% coinsurance applying only to routine eye exams and contact lenses. The plan covers one routine eye exam annually and provides a $200 yearly allowance for eyewear, including eyeglasses and upgrades with no coinsurance, while other eye exam services are not covered.
Dental Services See details
Passport Advantage (HMO D-SNP) dental services are partially covered, featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services. Sub-services not covered under this plan include other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Passport Advantage (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Passport Advantage (HMO D-SNP) plan 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 equipment, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and coverage may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Passport Advantage (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Home Health Services are covered by Passport Advantage (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Passport Advantage (HMO D-SNP) with no copay and require prior authorization, but only some services are covered in practice. Specifically, 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
Passport Advantage (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance and Medicare-defined copayments, requiring prior authorization. Additional days beyond the Medicare-covered limit are not covered, but the plan does allow admission with less than a three-day prior hospital stay.
Other Services See details
Passport Advantage (HMO D-SNP) partially covers Other Services, offering Over-the-Counter (OTC) items and qualifying meal benefits with no copay and no coinsurance. Acupuncture and other extra services are not covered under this plan benefit.
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