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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 2026 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) plan has an annual drug deductible of $615. Fortunately, 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 cost-sharing waiver applies to one-month, two-month, and three-month supplies. For other prescription categories, you will pay a percentage of the drug cost rather than a flat fee. Tier 2 generic and Tier 3 preferred brand drugs carry a 20% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance. Additionally, Tier 5 specialty drugs have a 25% coinsurance for a one-month supply.
Additional Benefits
The Passport Advantage (HMO D-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket expenses, featuring no copays for the majority of covered medical services. Members can access essential care such as inpatient hospital stays, home health services, preventive exams, and routine dental and hearing benefits with no copay and no coinsurance. Additionally, the plan provides valuable extras like over-the-counter items and unlimited transportation to approved locations at no cost. For other medical needs, including outpatient care, specialist visits, diagnostic services, and durable medical equipment, members will pay no copay but are responsible for a coinsurance ranging from 20% to 30%. Vision benefits include no copays and a $200 annual allowance for eyewear, though routine exams require a 20% coinsurance. Skilled nursing facility care is subject to Medicare-defined copays but requires no coinsurance, ensuring predictable costs for transitionary care.
Inpatient Hospital See details
Passport Advantage (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, subject to prior authorization. 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 with no copay and a 20% coinsurance, which applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, ambulatory surgical center, and substance abuse services.
Partial Hospitalization See details
Passport Advantage (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance, although prior authorization is required.
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. The plan also provides transportation services with no copay or coinsurance for unlimited one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Passport Advantage (HMO D-SNP) with a 30% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within 24 hours. Urgently needed services also have a 30% coinsurance and no copay, while worldwide emergency, urgent, and transportation services are covered up to a $10,000 maximum limit with no copay and no coinsurance.
Primary Care See details
Passport Advantage (HMO D-SNP) covers primary care, specialist visits, mental health, and physical therapy services with no copay and coinsurance ranging from 20% to 30%. This benefit is partially covered because podiatry services and non-routine chiropractic services are not covered.
Preventive Services See details
Passport Advantage (HMO D-SNP) covers preventive services with no copay and no coinsurance for annual physical exams and select additional benefits, while kidney disease education and other screenings require a 20% coinsurance and no copay. This benefit is partially covered, as sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and counseling are not covered.
Hearing Services See details
Passport Advantage (HMO D-SNP) covers hearing exams with no copay, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance, but inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Passport Advantage (HMO D-SNP) provides partially covered vision services with no deductibles, offering no copays for covered services but requiring a 20% coinsurance for routine eye exams and contact lenses. Covered eyewear, including eyeglasses and contacts, features a $200 annual maximum benefit, while other eye exam services are not covered.
Dental Services See details
Passport Advantage (HMO D-SNP) offers partially covered dental services, featuring no copay and a 20% coinsurance for Medicare-covered dental care, and no copay and no coinsurance for covered preventive and comprehensive dental benefits. Sub-services that are not covered under this plan include other diagnostic and preventive dental services, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Passport Advantage (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with 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 durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and some items 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 with no copay, subject to a 20% coinsurance and prior authorization. This coverage applies to all diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Passport Advantage (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Passport Advantage (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and prior authorization, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Passport Advantage (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, subject to Medicare-defined copays and prior authorization. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered, though a three-day prior inpatient hospital stay is not required for admission.
Other Services See details
Passport Advantage (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture is not covered under this benefit.
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