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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 2025, 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 2025.
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 $50.60. 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 $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:
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Drug Coverage
The Prime Health Complete (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, and then you enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). The plan does not specify the cost-sharing amounts for each drug tier.
Additional Benefits
The Prime Health Complete (HMO D-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with coinsurance costs depending on the specific service. The plan also covers primary care, preventive services, and home health services, often with no copay. Additional benefits include vision and dental services, hearing exams, and coverage for medical equipment. The plan also provides coverage for home infusion, dialysis, and skilled nursing facility services. Certain services, such as emergency services and ambulance services, are covered with a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with coinsurance costs based on the original Medicare plan. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, with a 20% coinsurance for outpatient hospital and observation services, and a coinsurance of 20% for individual and group sessions for outpatient substance abuse. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Prime Health Complete (HMO D-SNP) plan, with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Prime Health Complete (HMO D-SNP) plan, with a 20% coinsurance for both ground and air ambulance services and no copay. Transportation services to any health-related location are covered, while transportation services to a plan-approved health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, are covered by the Prime Health Complete (HMO D-SNP) plan with a 20% coinsurance, and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Prime Health Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, 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. Individual and group sessions for mental health and psychiatric services and opioid treatment program services have a minimum and maximum coinsurance of 20%. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Prime Health Complete (HMO D-SNP) plan covers preventive services including Medicare-covered services with no copay, and additional preventive services. The plan does not cover annual physical exams, health education, medical nutrition therapy (MNT), 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 benefits, 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. Kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance. In-Home Safety Assessment and Personal Emergency Response System (PERS) are covered. Fitness benefits include reimbursement for fitness facility membership up to $30 per month. Home and Bathroom Safety Devices and Modifications are covered with a maximum plan benefit coverage amount of $3000 every year.
Hearing Services See details
Hearing Services are partially covered under the Prime Health Complete (HMO D-SNP) plan. Hearing exams are covered with a 20% coinsurance, but routine hearing exams and fitting/evaluation for hearing aids are not covered; prescription hearing aids (all types, inner ear, outer ear, and over the ear) are not covered; and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear upgrades have a maximum plan benefit coverage amount of $150 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and routine eye exams are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services, orthodontic services, and restorative services. Adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, 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, Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. The coinsurance for Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Prime Health Complete (HMO D-SNP) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by Prime Health Complete (HMO D-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Prime Health Complete (HMO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no coinsurance. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Prime Health Complete (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Prime Health Complete (HMO D-SNP) plan. The plan does not cover any Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Prime Health Complete (HMO D-SNP) plan, with a service-specific out-of-pocket maximum of $200.00. The plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
The Prime Health Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $80.00 every month, and a meal benefit for a chronic illness with a maximum benefit coverage amount of $420.00 every year, but 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.
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