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Senior Care Plus Essential plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Care Plus Essential plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Care Plus Essential plan (HMO) in 2025, please refer to our full plan details page.
Senior Care Plus Essential plan (HMO) is a HMO plan offered by Renown Health available for enrollment in 2025 to people living in Washoe, Carson City, Storey Counties, NV. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Senior Care Plus Essential plan (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 Senior Care Plus Essential plan (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 Senior Care Plus Essential plan (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 $2700.00 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 Senior Care Plus Essential plan (HMO) has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $12.00 copay for a Tier 1 drug at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Senior Care Plus Essential plan (HMO) offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and ambulance services. The plan also covers primary care visits, preventive services, and hearing and vision services, with varying copays and coinsurance amounts. Additional benefits include dental services, home infusion, and dialysis services. Medical equipment, diagnostic and radiological services, and home health services are also covered. However, some services, such as cardiac rehabilitation and certain other services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $250 copay for days 1-4 and no copay for days 5-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered by the Senior Care Plus Essential plan (HMO). Outpatient Hospital Services have a copay of $0 to $440, and Observation Services have a copay of $300 to $440. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have a 20% coinsurance. Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $50.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Care Plus Essential plan (HMO) with a doctor referral. You will pay a $130 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $275 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Senior Care Plus Essential plan (HMO). Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $20-$65 copay and no coinsurance. Worldwide Emergency Coverage has a $140 copay, and Worldwide Urgent Coverage has a $65 copay, both with no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The Senior Care Plus Essential plan (HMO) covers Primary Care Physician Services with a copay between $0-$10, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $30 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health, Psychiatric, and Opioid Treatment Program Services have a copay of $30-$50 for individual or group sessions, and routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Senior Care Plus Essential plan (HMO) covers preventive services, including annual physical exams, health education, in-home safety assessments, post-discharge in-home medication reconciliation, additional sessions of smoking and tobacco cessation counseling (up to 10 visits), fitness benefits (memory fitness), enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Some services are not covered, including Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, and Counseling Services.
Hearing Services See details
Hearing Services include hearing exams, with a $45 copay, and prescription hearing aids, with a copay between $495 and $1970. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with 20% coinsurance for contact lenses, with a combined maximum of $250 every year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $40 copay, as well as Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning). Fluoride Treatment, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Care Plus Essential plan (HMO). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) subject to a 20% coinsurance and Prosthetic Devices subject to 20% coinsurance; Diabetic Supplies have a coinsurance between 0% and 20%, while Medical Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Senior Care Plus Essential plan (HMO), with a doctor referral required for all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $275, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $100, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Senior Care Plus Essential plan (HMO) with no copay or 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 Senior Care Plus Essential plan (HMO). The plan does not provide coverage for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Senior Care Plus Essential plan (HMO), but require prior authorization. You will pay a copay of $20 for days 1-20, $200 for days 21-34, and no copay for days 35-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum plan benefit of $50 every three months, while acupuncture, meal benefits, 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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