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Prime Health Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Prime 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 Prime Health Complete (HMO D-SNP) in 2026, please refer to our full plan details page.
Prime 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 3.5 out of 5 stars in 2026.
It's important to know that Prime 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:
Prime 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 Prime 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 Prime Health Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.70. 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 $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 Prime Health Complete (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you will pay out-of-pocket for your medications before your plan coverage kicks in. Understanding this initial cost is a key step in evaluating if this plan fits your healthcare budget. Specific drug tier details, including copay and coinsurance amounts for individual medications, are not available for this plan. To determine your exact out-of-pocket expenses for specific prescriptions, it is recommended to review the plan's formulary. This will help you verify how your specific medications are covered under the $615 deductible.
Additional Benefits
The Prime Health Complete (HMO D-SNP) plan provides robust medical coverage, featuring no copays for inpatient hospital stays, primary care visits, specialist consultations, and outpatient services. While inpatient care and home health services carry no coinsurance, several other key benefits—including outpatient services, emergency care, and medical equipment—require a 20% coinsurance. Diagnostic lab services are also highly accessible, requiring no copay and no coinsurance. For extra wellness benefits, the plan includes no copay and no coinsurance for diagnostic hearing exams, Medicare-covered dental services, and a $30 monthly fitness benefit. Members can also access a $25 monthly over-the-counter allowance and up to $150 annually for eyewear upgrades with no copays or coinsurance. However, routine services like standard eye exams, dental cleanings, and hearing aids are not covered by this plan.
Inpatient Hospital See details
Inpatient hospital and psychiatric care are partially covered by Prime Health Complete (HMO D-SNP) with no copay and no coinsurance. However, additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Prime Health Complete (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Prime Health Complete (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Prime Health Complete (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Prime Health Complete (HMO D-SNP) with a 20% coinsurance and no copay for emergency and urgently needed services, which is waived if you are admitted to the hospital within three days. While some worldwide emergency services are covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Prime Health Complete (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance, alongside covered telehealth benefits. Podiatry services are not covered, and while some chiropractic services are covered with no copay and 20% coinsurance, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Prime Health Complete (HMO D-SNP), featuring Medicare-covered preventive care, in-home safety assessments, and a fitness benefit of up to $30 per month with no copay and no coinsurance. Kidney disease education and other select screenings carry no copay and a 20% coinsurance, while several benefits—including annual physical exams, weight management, and personal emergency response systems—are not covered.
Hearing Services See details
Hearing services are partially covered by Prime Health Complete (HMO D-SNP), which provides diagnostic hearing exams with no copay, no deductible, and no coinsurance. However, routine hearing exams, fitting and evaluations, and all prescription and over-the-counter hearing aids are not covered.
Vision Services See details
Prime Health Complete (HMO D-SNP) covers some vision services, though routine eye exams, other eye exam services, contact lenses, and eyeglasses are not covered. Covered eyewear upgrades feature no copay and no coinsurance, up to a maximum plan benefit of $150 per year.
Dental Services See details
Prime Health Complete (HMO D-SNP) partially covers dental services, providing Medicare-covered dental and restorative services with no copay and no coinsurance, subject to prior authorization. Restorative services are limited to one visit per year, while other services, including oral exams, cleanings, x-rays, preventive care, endodontics, periodontics, and orthodontics, are not covered.
Home Infusion bundled Services See details
Prime Health Complete (HMO D-SNP) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Prime Health Complete (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Prime Health Complete (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Prime Health Complete (HMO D-SNP) with prior authorization required and no copays. Covered diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays are subject to a 20% coinsurance, while lab services are covered with no coinsurance.
Home Health Services See details
Home health services are covered under Prime Health Complete (HMO D-SNP) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Prime Health Complete (HMO D-SNP) with no copay, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Prime Health Complete (HMO D-SNP) with no copay and Medicare-defined coinsurance, requiring a prior three-day inpatient hospital stay. Additional days beyond the Medicare-covered limit are not covered under this plan.
Other Services See details
Prime Health Complete (HMO D-SNP) partially covers other services with no copay and no coinsurance, which includes an over-the-counter (OTC) item reimbursement of up to $25 monthly and a chronic illness meal benefit of up to $420 annually with prior authorization. Acupuncture, Nicotine Replacement Therapy, and Naloxone are not covered under this plan's other services benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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