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Abilis Health (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Abilis Health (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Abilis Health (HMO I-SNP) in 2026, please refer to our full plan details page.
Abilis Health (HMO I-SNP) is a HMO I-SNP plan offered by BrightSpring Health Services, Inc. available for enrollment in 2025 to people living in KY (partial), TN (partial). This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Abilis Health (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:
Abilis Health (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 Abilis Health (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 Abilis Health (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.90. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $12.00. 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 $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 Abilis Health (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Understanding this upfront cost is an important factor when estimating your overall yearly healthcare expenses. Specific drug tier details, including individual copayments and coinsurance percentages, are not currently available for this plan. To determine your exact costs for specific prescriptions, you will need to review the plan's formulary to verify how your medications are classified.
Additional Benefits
The Abilis Health (HMO I-SNP) plan offers comprehensive medical coverage featuring no copay for most major services, although a standard 20% coinsurance applies to outpatient care, diagnostics, emergency visits, and durable medical equipment. Inpatient hospital stays require no copay with Medicare-defined coinsurance, while skilled nursing facility care for days 1 through 100 and home health services are fully covered with no copay and no coinsurance. Primary care, specialist visits, and preventive services also feature no copay, with coinsurance rates varying from 0% to 20%. For supplemental care, members benefit from routine dental cleanings and exams with no copay and no coinsurance, alongside a $2,000 annual limit for comprehensive dental services at a 20% coinsurance. Vision and hearing benefits include no copay with a 20% coinsurance for routine exams, a $275 annual eyewear allowance, and up to $4,000 every two years for prescription hearing aids. Additionally, the plan provides a $200 quarterly reimbursement for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Abilis Health (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services with no copay, though Medicare-defined coinsurance applies and prior authorization is required. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered under the Abilis Health (HMO I-SNP) plan with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization services are covered by Abilis Health (HMO I-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Abilis Health (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Emergency services and urgently needed care under Abilis Health (HMO I-SNP) are covered with a 20% coinsurance and no copay, subject to a maximum of $90 for emergency visits and $40 for urgent care. This coinsurance is waived if admitted to the hospital within one day and counts toward the plan-level deductible, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Abilis Health (HMO I-SNP) covers primary care, specialist, mental health, and therapy services with no copay and coinsurance ranging from 0% to 20%. Some chiropractic services are covered, but routine care and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Abilis Health (HMO I-SNP) with no copay and no coinsurance for covered benefits, such as kidney disease education, home-based palliative care, and select screenings. However, several sub-services are not covered, including annual physical exams, health education, fitness benefits, and in-home safety assessments.
Hearing Services See details
Hearing services are partially covered by Abilis Health (HMO I-SNP), offering routine hearing exams with no copay and 20% coinsurance, and prescription hearing aids up to $4,000 every two years with no copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Abilis Health (HMO I-SNP) covers vision services with no copayments or deductibles, though a 20% coinsurance applies to routine eye exams and contact lenses. Members receive one routine eye exam and one glaucoma test annually, plus a $275 yearly maximum allowance for eyewear including contacts, lenses, frames, and upgrades.
Dental Services See details
Abilis Health (HMO I-SNP) offers partially covered dental services, with no copay and no coinsurance for routine exams, cleanings, and x-rays, while fluoride, other diagnostic, and other preventive services are not covered. Medicare dental and comprehensive services, including restorative, endodontics, and implants, are covered up to a $2,000 annual limit with no copay and a 20% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Abilis Health (HMO I-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Abilis Health (HMO I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Abilis Health (HMO I-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Abilis Health (HMO I-SNP) covers diagnostic and radiological services, including lab work, X-rays, and therapeutic radiology, with no copay and a 20% coinsurance. Prior authorization is required for all services, and diagnostic procedures and lab services also require a referral.
Home Health Services See details
Home Health Services are covered by Abilis Health (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Abilis Health (HMO I-SNP) offers Cardiac Rehabilitation Services with no copay and a prior authorization requirement. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Abilis Health (HMO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, though prior authorization is required. This benefit allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Abilis Health (HMO I-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $200 reimbursement every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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