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Sentara Medicare Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sentara Medicare Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sentara Medicare Value (HMO) in 2025, please refer to our full plan details page.
Sentara Medicare Value (HMO) is a HMO plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in Roanoke/Alleghany/Southwest. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Sentara Medicare Value (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 Sentara Medicare Value (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 Value (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.
This plan has a $150.00 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 $3900.00 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 Sentara Medicare Value (HMO) plan has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you may pay $10 for preferred generic drugs at a preferred pharmacy, or 31% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Sentara Medicare Value (HMO) plan offers comprehensive coverage with a variety of benefits. This plan provides coverage for inpatient hospital stays with a copay, outpatient services, and emergency services. You'll also find coverage for primary care visits with no copay, and preventive services with no copay for Medicare-covered services. This plan also includes additional benefits like hearing, vision, and dental services. Hearing services include hearing exams and hearing aids up to $2,000 annually, while vision covers routine eye exams and eyewear with a combined maximum benefit of $200 per year. Dental services cover oral exams, X-rays, and cleanings with no copay, while restorative services have a copay of $35.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $285 for days 1-7 and no copay for days 8-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a copay of $280.00. Ambulatory Surgical Center (ASC) Services have a copay of $195.00. Outpatient Substance Abuse Services are not covered, and Outpatient Blood Services are covered with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Sentara Medicare Value (HMO) plan, with a $35 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Sentara Medicare Value (HMO) plan. Ground and air ambulance services have a copay of $265.00, and transportation services to a plan-approved health-related location are covered for 36 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Sentara Medicare Value (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $15 copay, and Worldwide Emergency Services have a $50 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Sentara Medicare Value (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $30 copay for individual and group sessions, Other Health Care Professional services with a copay between $0 and $20, Psychiatric Services with a $30 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $20 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services. Podiatry Services are not covered.
Preventive Services See details
The Sentara Medicare Value (HMO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, Personal Emergency Response System (PERS), re-admission prevention, nutritional/dietary benefits, In-Home Support Services, additional sessions of smoking and tobacco cessation counseling, fitness benefits, 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. The plan does not cover 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.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $20 copay, routine hearing exams, and fitting/evaluation for hearing aids, and prescription hearing aids (all types). Prescription hearing aids are covered up to a maximum of $2,000 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Sentara Medicare Value (HMO) covers vision services including routine eye exams with one visit 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 Value (HMO) covers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have a $35 copay. Orthodontic services are covered up to a maximum of $2500. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Sentara Medicare Value (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Sentara Medicare Value (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered by the Sentara Medicare Value (HMO) plan. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and outpatient X-ray services, with a copay up to $85 for diagnostic procedures and no copay for outpatient X-ray services; therapeutic radiological services have a copay up to $30 and 20% coinsurance. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Sentara Medicare Value (HMO) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sentara Medicare Value (HMO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $156 every three months, and the plan offers Nicotine Replacement Therapy as a Part C OTC benefit, but acupuncture, meal benefits, and several other services are not covered.
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