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Signature Advantage Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Signature Advantage Plan (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Signature Advantage Plan (HMO I-SNP) in 2025, please refer to our full plan details page.
Signature Advantage Plan (HMO I-SNP) is a HMO I-SNP plan offered by SA Plan, LLC available for enrollment in 2025 to people living in KY (partial), TN (partial). This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Signature Advantage Plan (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Signature Advantage Plan (HMO I-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 Signature Advantage Plan (HMO I-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 Signature Advantage Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.30. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $19.50. 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 $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 Signature Advantage Plan (HMO I-SNP) has a deductible of $590.00. After you meet your deductible, you will pay the costs for your drugs. This plan's premium may be reduced if you qualify for the low-income subsidy. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Signature Advantage Plan (HMO I-SNP) offers a range of benefits with varying cost-sharing. Many services, such as preventive care, home health, and diagnostic and radiological services, have no copay, while others like inpatient hospital, outpatient services, and emergency services require a 20% coinsurance. Dental, vision, and hearing services are also included, with specific coinsurance rates and maximum benefits for certain services.
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. The plan requires prior authorization and has coinsurance costs.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center Services, Individual Sessions for Outpatient Substance Abuse and Group Sessions for Outpatient Substance Abuse have a 20% to 20% coinsurance. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Signature Advantage Plan (HMO I-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Signature Advantage Plan (HMO I-SNP). Ground and air ambulance services are covered with a 20% coinsurance, and there is no copay. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, and Urgently Needed Services are covered under the Signature Advantage Plan (HMO I-SNP), with a 20% coinsurance, and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a 0%-20% coinsurance, Chiropractic Services with a 20% coinsurance, Occupational Therapy Services with a 20% coinsurance, Physician Specialist Services with a 20% coinsurance, Mental Health Specialty Services with a coinsurance between 0%-20%, Podiatry Services with a 20% coinsurance, Other Health Care Professional services with a coinsurance between 0%-20%, Psychiatric Services with a coinsurance between 0%-20%, Physical Therapy and Speech-Language Pathology Services with a 20% coinsurance, Additional Telehealth Benefits with a coinsurance between 0%-20%, and Opioid Treatment Program Services with a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Signature Advantage Plan (HMO I-SNP) covers Medicare-covered preventive services, with no copay. Additional preventive services are partially covered, with the following services not covered: Annual Physical Exam, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services. Home-Based Palliative Care, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered with coinsurance of at most 20% for one visit every year, and fitting/evaluation for hearing aids are covered with no coinsurance. Prescription hearing aids are covered up to $4000 every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Signature Advantage Plan (HMO I-SNP) covers vision services including eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a combined maximum benefit of $275 per year. Routine eye exams and other eye exam services are covered. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Signature Advantage Plan (HMO I-SNP) covers dental services, with a 20% coinsurance for Medicare Dental Services. Other dental services include Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Orthodontic Services, with the following details: Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are limited to 2 visits every year, while Fluoride Treatment is not covered. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are covered with 20% coinsurance. Orthodontic Services have a maximum benefit of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Signature Advantage Plan (HMO I-SNP) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance; there is no copay for any of these services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Signature Advantage Plan (HMO I-SNP), with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Signature Advantage Plan (HMO I-SNP) with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Signature Advantage Plan (HMO I-SNP). Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage, and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
Other Services, including acupuncture, meal benefits, 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. Over-the-counter items are covered, with a maximum benefit of $400 every three months.
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