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Sentara Medicare Salute (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sentara Medicare Salute (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sentara Medicare Salute (HMO) in 2025, please refer to our full plan details page.
Sentara Medicare Salute (HMO) is a HMO plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in State of Virginia. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Sentara Medicare Salute (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Sentara Medicare Salute (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 Sentara Medicare Salute (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.
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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3550.00 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
Prescription drugs are not covered by Sentara Medicare Salute (HMO).
Additional Benefits
The Sentara Medicare Salute (HMO) plan offers a wide range of benefits with varying costs. For inpatient hospital stays, you'll pay a $290 copay for days 1-6, with no copay for the remainder of your stay. Outpatient services have copays ranging from $35-$285, and primary care visits cost between $20-$30. Preventive services, routine eye exams, and many dental services have no copay. The plan also covers hearing aids up to $2000 per year and offers coverage for durable medical equipment, prosthetic devices, and home health services with varying coinsurance or no copay.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered, but require prior authorization. For days 1-6, the copay is $290, and there is no copay for days 7-90. Additional days for both acute and psychiatric care are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a $285 copay, while Ambulatory Surgical Center (ASC) Services have a $245 copay. Outpatient Substance Abuse Services are not covered, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Sentara Medicare Salute (HMO) plan, but requires prior authorization. You will pay a $35 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sentara Medicare Salute (HMO) plan. All ambulance services have no coinsurance, but have a $265 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered, with up to 36 one-way trips per year, and no coinsurance. Transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Sentara Medicare Salute (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $50 copay.
Primary Care See details
The Sentara Medicare Salute (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy with a $30 copay, physician specialist services with a $30 copay, mental health specialty services, podiatry services with a $30 copay, other health care professional services with a copay ranging from $0 to $30, psychiatric services, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care and routine foot care have a $20 and $30 copay respectively, and each are limited to 18 and 8 visits per year.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with prior authorization, annual physical exams, additional preventive services, Health Education, Personal Emergency Response System (PERS), Nutritional/Dietary Benefit, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, with no copay for PERS, Enhanced Disease Management and Remote Access Technologies. In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, Support for Caregivers of Enrollees, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a plan-specified amount of $2000 every year. Prescription hearing aids (all types) are covered with a maximum of 2 visits per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and one exam covered per year, and eyewear with a combined maximum benefit of $200 per year. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Sentara Medicare Salute (HMO) covers dental services with no copay for other dental services, and a $0 copay for a combination of services including Dental X-Rays, Other Diagnostic Dental Services, Fluoride Treatment, and Other Preventive Dental Services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with 2 visits per year for each. Orthodontic services are covered up to a maximum of $1500 per year, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery have a $50 copay. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Sentara Medicare Salute (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Diabetic Equipment is also covered, however, Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Sentara Medicare Salute (HMO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $85, and Diagnostic Radiological Services with a copay of up to $275. Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $30, while Outpatient X-Ray Services have no copay. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Sentara Medicare Salute (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with prior authorization, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Sentara Medicare Salute (HMO) covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Sentara Medicare Salute (HMO) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $75 every three months, including Nicotine Replacement Therapy (NRT). Acupuncture, meal benefits, dual eligible SNPs with highly integrated services, and several other services are not covered.
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