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PrimeWest Senior Health Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PrimeWest Senior Health Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PrimeWest Senior Health Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
PrimeWest Senior Health Complete (HMO D-SNP) is a HMO D-SNP plan offered by PrimeWest Rural MN Health Care Access Initiative available for enrollment in 2025 to people living in Northern, west central, and southwestern Minnesota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that PrimeWest Senior Health Complete (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:
PrimeWest Senior Health Complete (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 PrimeWest Senior Health Complete (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 PrimeWest Senior Health Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.20. 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:
Sign up for PrimeWest Senior Health Complete (HMO D-SNP)
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Drug Coverage
The PrimeWest Senior Health Complete (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your drugs, which vary based on the drug tier and pharmacy type. Once your total drug costs reach $2,000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), the plan's premium may be reduced. During the initial coverage phase, you will pay the costs for your drugs until your total drug costs reach $2,000. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The PrimeWest Senior Health Complete (HMO D-SNP) plan offers a variety of benefits with varying cost-sharing. Many services, like ambulance services, emergency services, and home health services, have no copay. However, many services, including outpatient services, primary care, preventive services, hearing and vision services, medical equipment, and others, require a 20% coinsurance. The plan also covers dental services, home infusion, and dialysis services, each with their own cost-sharing structure. Additionally, the plan provides coverage for over-the-counter items up to $204 per month and meal benefits with a maximum benefit of $420 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, although specific services like additional days and non-Medicare-covered stays are not covered. The plan's cost sharing includes coinsurance, as defined by Medicare.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, each with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
The PrimeWest Senior Health Complete (HMO D-SNP) plan covers ambulance services with no copay, but with a 20% coinsurance for both ground and air ambulance services. Transportation Services - Any Health-related Location is covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a 20% coinsurance, and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, 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, while Routine Chiropractic Care is not covered. Occupational Therapy Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services all have a minimum and maximum coinsurance of 20%.
Preventive Services See details
Preventive Services are covered, with some services requiring a coinsurance. Medicare-covered Zero Dollar Preventive Services are covered with no copay and no coinsurance. Annual physical exams, health education, medical nutrition therapy, 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, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered. In-home safety assessments and personal emergency response systems (PERS) are covered. Fitness Benefit is covered with a maximum benefit coverage amount of $30.00. Home and Bathroom Safety Devices and Modifications are covered with a maximum benefit coverage amount of $3000.00 per year. 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 are partially covered by PrimeWest Senior Health Complete (HMO D-SNP), with a coinsurance of at most 20% for hearing exams. However, routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, while routine eye exams are not covered. Eyewear is covered, but contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are not covered. Upgrades are covered with a maximum plan benefit coverage amount of $150 every year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services, Orthodontic Services, Restorative Services, and Prosthodontics (removable). Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, 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, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the PrimeWest Senior Health Complete (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. 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 PrimeWest Senior Health Complete (HMO D-SNP) plan, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the PrimeWest Senior Health Complete (HMO D-SNP) plan with no coinsurance and no copay. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PrimeWest Senior Health Complete (HMO D-SNP) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the PrimeWest Senior Health Complete (HMO D-SNP) plan, with a service-specific out-of-pocket maximum of $200.00; however, additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services", 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. Over-the-counter (OTC) items are covered with a maximum benefit of $204 per month. Meal benefits are covered with a maximum benefit of $420 per year, and require prior authorization.
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