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 2026, 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 2026.
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.
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 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:
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Drug Coverage
The CoxHealth Medicare Advantage (HMO) plan offers a $0 drug deductible, allowing your prescription coverage to begin immediately without any out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies and no copay for Tier 6 select diabetic drugs at both preferred and standard pharmacies. Tier 2 generic medications are available for a low $10 copay for a one-month supply when filled at a preferred pharmacy. For higher-tier medications, Tier 3 preferred brand drugs cost a $47 copay and Tier 4 non-preferred drugs cost a $100 copay for a one-month supply at either preferred or standard pharmacies. Tier 5 specialty drugs require a 30% coinsurance, which applies to one-month supplies at preferred, standard, and standard mail-order pharmacies. Utilizing standard mail-order services for a three-month supply can help lower your expenses, offering no copay on Tier 1 and Tier 6 drugs.
Additional Benefits
The CoxHealth Medicare Advantage (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care and telehealth visits. Specialist visits require a $40 copay, while inpatient hospital stays cost a $295 daily copay for the first six days and no copay for subsequent days. Emergency services are available with a $125 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features strong supplemental benefits, including dental care with no copay or coinsurance up to a $3,000 annual limit. Routine vision and hearing exams are covered with low copays, and you will pay no copay for prescription hearing aids up to $1,150 per ear every two years and eyewear up to a $200 annual maximum. Additionally, members can take advantage of home health services with no copay and a quarterly over-the-counter allowance.
Inpatient Hospital See details
Inpatient hospital care is covered by CoxHealth Medicare Advantage (HMO) with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and while unlimited additional days are covered, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
CoxHealth Medicare Advantage (HMO) covers outpatient hospital, observation, and ambulatory surgical center services with a $295 copay and up to 20% coinsurance. Outpatient substance abuse services require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
CoxHealth Medicare Advantage (HMO) covers partial hospitalization services with a $50 copay and no coinsurance.
Ambulance and Transportation Services See details
CoxHealth Medicare Advantage (HMO) covers ground and air ambulance services with a $250 copay per service and no coinsurance, subject to prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
CoxHealth Medicare Advantage (HMO) covers emergency services with a $125 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, featuring no coinsurance and no deductible for either service. Worldwide emergency services are partially covered with a $125 copay and no coinsurance for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
CoxHealth Medicare Advantage (HMO) covers primary care and telehealth services with no copay and no coinsurance, while therapy services cost a $20 copay and specialist visits cost a $40 copay, both with no coinsurance. Chiropractic services are partially covered, with a $20 copay and no coinsurance for up to 26 routine visits per year, though other chiropractic services are not covered. Mental health, psychiatric, and podiatry services are also covered with a $35 copay and no coinsurance.
Preventive Services See details
CoxHealth Medicare Advantage (HMO) offers partially covered preventive services with no copay and no coinsurance, though prior authorization is required for Medicare-covered zero-dollar services. However, the plan does not cover an annual physical exam, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, or counseling services.
Hearing Services See details
CoxHealth Medicare Advantage (HMO) covers annual hearing exams and fitting evaluations with a $20 copay and no coinsurance, though OTC hearing aids are not covered. Prescription hearing aids feature no copay and no coinsurance up to a $1,150 maximum per ear every two years, but some services are covered as inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
CoxHealth Medicare Advantage (HMO) partially covers vision services, offering one routine eye exam per year for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contact lenses, frames, lenses, and upgrades, is covered with no copay and no coinsurance up to a combined maximum of $200 annually.
Dental Services See details
CoxHealth Medicare Advantage (HMO) provides partially covered dental services with no copay and no coinsurance up to an annual maximum of $3,000. While preventive and comprehensive services like cleanings, exams, and root canals are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
CoxHealth Medicare Advantage (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, insulin, and other drugs have a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
CoxHealth Medicare Advantage (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
CoxHealth Medicare Advantage (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no copay and 0% to 20% coinsurance from specified manufacturers, while diabetic therapeutic shoes and inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
CoxHealth Medicare Advantage (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Diagnostic procedures, lab services, and outpatient X-rays are available with no copay, while therapeutic radiological services require a minimum copay of $60 and diagnostic radiological services require a minimum copay of $150.
Home Health Services See details
CoxHealth Medicare Advantage (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
CoxHealth Medicare Advantage (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered under this plan, which carry copays ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
CoxHealth Medicare Advantage (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary for admission, and unlimited additional days are covered beyond the standard Medicare limit.
Other Services See details
CoxHealth Medicare Advantage (HMO) partially covers other services, featuring an over-the-counter (OTC) benefit with no copay and no coinsurance up to a $20 limit every three months via reimbursement. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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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.
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