A non-government entity
CMH Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for CMH Medicare Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on CMH Medicare Advantage (HMO) in 2026, please refer to our full plan details page.
CMH Medicare Advantage (HMO) is a HMO plan offered by CoxHealth available for enrollment in 2026 to people living in Counties: CEDAR DALLAS HICKORY DADE POLK. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that CMH 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 CMH 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 CMH 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 a $400.00 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 $4200.00 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 CMH Medicare Advantage (HMO) plan features a $400 drug deductible and offers excellent savings on everyday medications. For Tier 1 preferred generics and Tier 6 select diabetic drugs, you will pay no copay at preferred pharmacies. Tier 2 generic drugs are also highly affordable, with copays starting at $10 at preferred pharmacies and $15 at standard pharmacies for a one-month supply. For higher-tier medications, Tier 3 preferred brands have a $47 copay, while Tier 4 non-preferred drugs carry a $100 copay for a one-month supply. Specialty drugs in Tier 5 require a 28% coinsurance for a one-month supply across all pharmacy types. You can also save on mail-order prescriptions, which offer no copay for a three-month supply of Tier 1 and Tier 6 medications.
Additional Benefits
The CMH Medicare Advantage (HMO) plan offers comprehensive core medical coverage with predictable cost-sharing, including no copay for primary care or telehealth visits and a $55 copay for specialists. Inpatient hospital stays require a $350 daily copay for the first six days and no copay thereafter, while outpatient hospital services carry a $395 copay per visit with no coinsurance. Emergency care is covered with a $125 copay, and urgent care visits require a $50 copay, both with no coinsurance. This plan also features strong supplemental benefits, such as a $3,000 annual maximum for covered dental care and a $200 annual allowance for eyewear, both with no copays or coinsurance. Hearing services include a $20 copay for routine exams and up to $1,150 per ear every two years for prescription hearing aids with no copay. Additionally, members can access a $20 quarterly over-the-counter reimbursement benefit and diagnostic lab services with no copays.
Inpatient Hospital See details
CMH Medicare Advantage (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 and beyond. This benefit is partially covered, as prior authorization is required, and upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
CMH Medicare Advantage (HMO) covers outpatient hospital, observation, and ambulatory surgical center services with a $395 copay and no coinsurance. Outpatient substance abuse services require a $35 copay per session with no coinsurance, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
CMH Medicare Advantage (HMO) covers partial hospitalization services with a $50.00 copay and no coinsurance.
Ambulance and Transportation Services See details
CMH Medicare Advantage (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
CMH Medicare Advantage (HMO) covers emergency services with a $125 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency and urgent services are partially covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
CMH Medicare Advantage (HMO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Physical, occupational, and routine chiropractic therapies (limited to 26 visits; other chiropractic services are not covered) have a $20 copay and no coinsurance, while mental health, psychiatric, and podiatry services carry a $35 copay and no coinsurance.
Preventive Services See details
CMH Medicare Advantage (HMO) provides partial coverage for preventive services with no copay and no coinsurance, though prior authorization is required for Medicare-covered zero-dollar preventive services. Covered benefits include kidney disease education, glaucoma screenings, and memory fitness, while annual physical exams and health education are not covered.
Hearing Services See details
Hearing services are partially covered by CMH Medicare Advantage (HMO), featuring annual routine exams for a $20 copay and no coinsurance, alongside prescription hearing aids with no copay or coinsurance up to $1,150 per ear every two years. However, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
CMH Medicare Advantage (HMO) partially covers eye exams, offering one routine eye exam per year with a $35 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 annual maximum benefit for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered under the CMH Medicare Advantage (HMO) plan, offering a $3,000 maximum annual benefit with no copay and no coinsurance for covered diagnostic, preventive, restorative, and surgical care. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
CMH Medicare Advantage (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry a coinsurance of 0% to 20%, while covered insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the CMH Medicare Advantage (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by CMH Medicare Advantage (HMO) with no copays, although prior authorization is required. Durable medical equipment, prosthetics, and medical supplies carry a 20% coinsurance, while diabetic supplies range from no coinsurance to 20% coinsurance, and diabetic shoes or inserts have no coinsurance.
Diagnostic and Radiological Services See details
CMH Medicare Advantage (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. There is no copay for lab services, outpatient X-rays, and diagnostic procedures, while diagnostic radiological services require a minimum $150 copay and therapeutic radiological services require a minimum $60 copay.
Home Health Services See details
CMH Medicare Advantage (HMO) covers Home Health Services with a $20.00 copay and no coinsurance, subject to prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by CMH Medicare Advantage (HMO) with no coinsurance, but only some services are covered because cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation are not covered in practice.
Skilled Nursing Facility (SNF) See details
CMH Medicare Advantage (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $200 copay for days 21 through 100, and unlimited additional days are covered.
Other Services See details
Other services are partially covered by CMH Medicare Advantage (HMO), which offers an over-the-counter (OTC) benefit with no copay and no coinsurance up to a maximum of $20.00 every three months via reimbursement. Acupuncture, meal benefits, and other supplemental services in this category are not covered.
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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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