A non-government entity
CoxHealth Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CoxHealth Medicare Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CoxHealth Medicare Advantage (HMO) in 2025, please refer to our full plan details page.
CoxHealth Medicare Advantage (HMO) is a HMO plan offered by CoxHealth available for enrollment in 2025 to people living in Counties: GRE CHR WEB STO TAN BAR LAW. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that CoxHealth Medicare Advantage (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 CoxHealth Medicare Advantage (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 CoxHealth Medicare Advantage (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. Additionally, this plan comes with a Part B Premium reduction of $5.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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 CoxHealth Medicare Advantage (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The CoxHealth Medicare Advantage (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, and standard generic drugs have a $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The CoxHealth Medicare Advantage (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services and emergency services have copays as well. The plan covers primary care with no copay, and offers additional benefits for hearing, vision, and dental services, all with their own specific copays and maximum benefits. This plan also covers services like home health, diagnostic, and home infusion with either no copay or coinsurance. The plan includes coverage for services like hearing exams, vision exams, and dental care, as well as durable medical equipment. With this plan, you'll also receive coverage for ambulance services, skilled nursing facilities, and partial hospitalization, with associated copays.
Inpatient Hospital See details
Inpatient Hospital benefits cover both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $295 for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute and Psychiatric are also covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services and observation services have a $295 copay and 0%-20% and 20% coinsurance, respectively. Ambulatory surgical center services have a $295 copay and 20% coinsurance. Individual and group sessions for outpatient substance abuse have a $35 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the CoxHealth Medicare Advantage (HMO) plan. You will pay a $50 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the CoxHealth Medicare Advantage (HMO) plan. Both ground and air ambulance services have a $250 copay, but no coinsurance. Transportation services to a health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency and Urgent Coverage, are covered by the CoxHealth Medicare Advantage (HMO) plan. Emergency Services have a $125 copay, and Urgent Services have a $50 copay, with no coinsurance for either. Worldwide Emergency Transportation is not covered.
Primary Care See details
The CoxHealth Medicare Advantage (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 $35 copay, and mental health specialty services with a $35 copay for individual and group sessions. This plan also covers podiatry services with a $35 copay, other health care professional services with a copay between $0 and $40, psychiatric services with a $35 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 with a $40 copay.
Preventive Services See details
The CoxHealth Medicare Advantage (HMO) plan covers preventive services, including Medicare-covered preventive services with no copay and additional preventive services such as fitness benefit, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit; however, annual physical exams, health education, in-home safety assessment, personal emergency response system, 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, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services and other preventive services are also covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, and prescription hearing aids with a maximum plan benefit coverage of $1150 every two years. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year, while Prescription Hearing Aids (all types) are covered once every two years. OTC hearing aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include routine eye exams with a $35 copay, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The CoxHealth Medicare Advantage (HMO) plan covers dental services with a maximum benefit of $3,000 per year. Oral exams and cleanings are covered twice per year, while dental x-rays, other diagnostic dental services, fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery are covered once per year. Maxillofacial prosthetics, implant services, 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. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the CoxHealth Medicare Advantage (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
The CoxHealth Medicare Advantage (HMO) plan covers Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetic Devices and Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the CoxHealth Medicare Advantage (HMO) plan, with no copay for Diagnostic Procedures/Tests and Lab Services. Diagnostic Radiological Services have a copay of at most $150, while Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the CoxHealth Medicare Advantage (HMO) 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 covered by the CoxHealth Medicare Advantage (HMO) plan, but the specific services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. The plan has a copay for covered services, but the exact amount is not specified in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the CoxHealth Medicare Advantage (HMO) plan, with a $0 copay for days 1-20 and a $160 copay per day for days 21-100; additional days beyond Medicare coverage are also covered. Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $90 every three months, and Nicotine Replacement Therapy (NRT) is covered. Acupuncture, Meal Benefit, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved