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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 you meet your deductible, the plan will cover the costs of your drugs until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your Part D premium will be $26.60. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Passport Advantage (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services require coinsurance, often 20%, including outpatient services, primary care, preventive services, vision, dental, and medical equipment. Some services have no copay, such as Home Health Services, Diagnostic and Radiological Services and Transportation Services to any health-related location. The plan also includes coverage for emergency services, hearing services, home infusion, and dialysis services, with specific cost-sharing details outlined in the plan documents. Some services, such as inpatient hospital stays, Skilled Nursing Facility (SNF) benefits, and partial hospitalization, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days and non-Medicare-covered stays are not covered. Copays apply for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with details available in the plan documents.
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 individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services with a 20% coinsurance, and Transportation Services to any health-related location, with no copay or coinsurance. Transportation Services to a plan-approved health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Passport Advantage (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services has a maximum benefit coverage of $10,000 and no copay.
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 and speech-language pathology services have a 20% coinsurance. Occupational therapy services, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a coinsurance of 20%. Podiatry Services are not covered.
Preventive Services See details
The Passport Advantage (HMO D-SNP) plan covers preventive services, including an annual physical exam. Additional preventive services, health education, personal emergency response systems, nutritional/dietary benefits (12 visits), additional sessions of smoking and tobacco cessation counseling (8 visits), fitness benefits, remote access technologies, kidney disease education services, and other preventive services are also covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a coinsurance of at most 20%, Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids (all types) with 2 visits every two years, and OTC Hearing Aids with a quantity of 2 every two years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have a 20% coinsurance, with a combined maximum benefit of $200 per year for all eyewear.
Dental Services See details
The Passport Advantage (HMO D-SNP) plan covers dental services, including Medicare dental services with 20% coinsurance. Other dental services include oral exams (2 visits per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), and restorative services (1 per year). Orthodontic services are covered up to a maximum of $500 per year. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. You will pay a $35 copay for Medicare Part B Insulin Drugs, with coinsurance between 0-20%, and coinsurance between 0-20% for both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Passport Advantage (HMO D-SNP) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, are covered under the Passport Advantage (HMO D-SNP) plan. There is a 20% coinsurance for durable medical equipment, and for medical supplies, prosthetics, diabetic supplies, and diabetic therapeutic shoes/inserts. Durable medical equipment for use outside of the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Passport Advantage (HMO D-SNP) plan. All diagnostic and radiological services have no copay and a coinsurance of at most 20%.
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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Passport Advantage (HMO D-SNP) plan, but require prior authorization. The plan does not cover additional days beyond Medicare coverage for SNF, nor does it cover non-Medicare-covered SNF stays.
Other Services See details
Other Services offered by the Passport Advantage (HMO D-SNP) plan include Over-the-Counter (OTC) Items and a Meal Benefit. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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. The Meal Benefit requires prior authorization.
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