A non-government entity
Astiva Health Savings Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Astiva Health Savings Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Astiva Health Savings Plan (HMO) in 2026, please refer to our full plan details page.
Astiva Health Savings Plan (HMO) is a HMO plan offered by Astiva Health Holdings Incorporated available for enrollment in 2025 to people living in Counties: OC, LA, RIV, SB, SD. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Astiva Health Savings Plan (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Astiva Health Savings Plan (HMO).
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 Astiva Health Savings Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $185.00. You must continue to pay paying your reduced 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 $50.00 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 $3045.00 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 Astiva Health Savings Plan (HMO) features an Enhanced Alternative drug benefit with a low $50 prescription drug deductible. During the initial coverage phase, you will pay a $12 copay for preferred generics and a $45 copay for standard generics at standard pharmacies. Preferred brand drugs require a $98 copay, non-preferred drugs carry a 29% coinsurance, and specialty tier drugs feature no copay. These cost-sharing rates apply until your total drug costs reach $2,100, at which point you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy will benefit from a full premium reduction, resulting in no cost for their Part D coverage.
Additional Benefits
The Astiva Health Savings Plan (HMO) offers essential medical coverage featuring no copay for primary care visits, urgently needed services, and medical equipment like diabetic supplies. Outpatient services are highly accessible, with a low $15 copay for substance abuse sessions, a $25 copay for mental health care, and a $75 copay for ambulatory surgical center visits. While emergency room visits carry a $125 copay, other specialized treatments like dialysis and therapeutic radiology require a 20% coinsurance. Beyond core medical care, the plan includes routine vision and hearing benefits with no deductibles, offering a $125 eyewear allowance every two years and up to $500 per ear annually for prescription hearing aids. Dental benefits are also available with no copay up to a maximum of $250 every three months, though Medicare-covered dental services require a 20% coinsurance. Please note that this plan does not cover health-related transportation or cardiac rehabilitation services.
Inpatient Hospital See details
Astiva Health Savings Plan (HMO) partially covers Inpatient Hospital acute and psychiatric services, which require prior authorization and referrals but feature no cost-sharing on the day of discharge. Specific copay and coinsurance rates are not specified, and exclusions apply to upgrades and non-Medicare-covered stays.
Outpatient Services See details
Astiva Health Savings Plan (HMO) covers outpatient services, including ambulatory surgical center visits for a $75 copay and outpatient substance abuse sessions for a $15 copay, both with no coinsurance. Outpatient hospital, observation, and blood services are also covered with no deductible, though most outpatient services require a doctor referral and prior authorization.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Astiva Health Savings Plan (HMO) with an $80 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
Ambulance services are covered by the Astiva Health Savings Plan (HMO) with a $150 copay for ground transportation and a 20% coinsurance for air transportation, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Astiva Health Savings Plan (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if you are hospitalized within 48 hours, and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $100,000 maximum limit, though worldwide emergency transportation is not covered.
Primary Care See details
Primary Care benefits are partially covered by the Astiva Health Savings Plan (HMO), which excludes podiatry services and routine chiropractic care. Covered services generally require prior authorization and a doctor referral, featuring no copay or coinsurance for primary care visits, a $15 copay and no coinsurance for opioid treatment, and a $25 copay and no coinsurance for mental health and psychiatric sessions.
Preventive Services See details
Preventive services are partially covered by the Astiva Health Savings Plan (HMO) with no copay or coinsurance for Medicare-covered zero-dollar services. While alternative therapies and therapeutic massages are covered, several services—including annual physical exams, health education, weight management programs, and in-home safety assessments—are not covered.
Hearing Services See details
Hearing services are partially covered by the Astiva Health Savings Plan (HMO) with no deductible, though copay and coinsurance information is not specified. The plan covers annual routine exams, fitting evaluations, and up to $500 per ear yearly for prescription hearing aids, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by the Astiva Health Savings Plan (HMO), which features no deductibles and covers one routine eye exam every year. The plan also provides a combined $125 eyewear allowance every two years for eyeglasses and contact lenses, though eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Astiva Health Savings Plan (HMO), which excludes maxillofacial prosthetics and orthodontics from coverage. Medicare-covered dental services require a 20% coinsurance and no copay, while other covered dental services have no copay or coinsurance and are subject to a maximum benefit of $250 every three months.
Home Infusion bundled Services See details
Astiva Health Savings Plan (HMO) covers home infusion bundled services with prior authorization, featuring no copay and 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Astiva Health Savings Plan (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive this covered benefit.
Medical Equipment See details
Astiva Health Savings Plan (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays. Prior authorization is required for these services, which feature coinsurance ranging from no coinsurance up to 20% depending on the specific item.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by the Astiva Health Savings Plan (HMO), though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services range from no copay up to $50, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Astiva Health Savings Plan (HMO), though members must obtain prior authorization and a doctor referral to receive these services.
Cardiac Rehabilitation Services See details
Astiva Health Savings Plan (HMO) states some services are covered for Cardiac Rehabilitation Services, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice. Because these services are not covered, there is no plan copay or coinsurance, and members must pay all costs out-of-pocket.
Skilled Nursing Facility (SNF) See details
Astiva Health Savings Plan (HMO) partially covers Skilled Nursing Facility (SNF) care, requiring prior authorization and a doctor referral with no prior inpatient hospital stay required. There is no copay or cost-sharing charged on the day of discharge, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Astiva Health Savings Plan (HMO), with no copays or coinsurance specified for covered acupuncture, chronic illness meals, and over-the-counter items. Excluded services under this benefit include nicotine replacement therapy, naloxone, and highly integrated dual-eligible SNP services.
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