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Advantage Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Advantage Care (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Advantage Care (HMO) in 2025, please refer to our full plan details page.
Advantage Care (HMO) is a HMO plan offered by Curana Health Holdings, LLC available for enrollment in 2025 to people living in California (Partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Advantage Care (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 Advantage Care (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 Advantage Care (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 $10.00. 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 $1900.00 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 Advantage Care (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, a standard generic drug has a $45 copay, while a preferred brand drug has a $95 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The Advantage Care (HMO) plan offers comprehensive coverage, including no copays for inpatient hospital stays, and a wide range of outpatient services with varying copays or coinsurance. The plan also covers primary care, preventive services, vision, and dental, with specific cost-sharing amounts for each. Additional benefits include coverage for ambulance services, emergency services, home health, skilled nursing, and medical equipment, with some services requiring coinsurance. The plan also provides coverage for acupuncture, and over-the-counter items. However, it's important to note that certain services like cardiac rehabilitation, and some transportation services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits for Advantage Care (HMO) include coverage for Inpatient Hospital-Acute, with no copay for a Medicare-covered stay and additional days, and Inpatient Hospital Psychiatric, with a $0 copay for days 1-3, a $100 copay for days 4-10, and a $0 copay for days 11-90. Upgrades and Non-Medicare-covered stays for Inpatient Hospital-Acute and Non-Medicare-covered stays and additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay of $0-$225, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with 20% coinsurance, while Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Advantage Care (HMO) plan. Ground ambulance services have a $125 copay, while air ambulance services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Advantage Care (HMO) plan. Emergency services have a $90 copay and no coinsurance, while urgently needed services have a $40 copay and no coinsurance. Worldwide emergency services, urgent coverage, and emergency transportation are not covered.
Primary Care See details
The Advantage Care (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Routine Chiropractic Care has a $30 copay for 12 visits per year. Routine Foot Care has a 20% coinsurance, with a maximum of 6 visits per year. Individual and Group Sessions for Psychiatric Services have a 20% coinsurance. Additional Telehealth Benefits have no copay.
Preventive Services See details
The Advantage Care (HMO) plan covers preventive services, including those covered by Medicare with no copay. However, the plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, 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 benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services. Other covered preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing Services are partially covered by the Advantage Care (HMO) plan. Hearing exams have a coinsurance of at most 20%, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, also has a 20% coinsurance with a combined maximum of $225 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance and other dental services with no maximum plan benefit coverage. Orthodontic Services has a maximum plan benefit of $3000 per year.
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. The plan has a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance for all covered services ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Advantage Care (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Advantage Care (HMO) plan, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, with a 20% coinsurance for some services, and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, diagnostic radiological services, and therapeutic radiological services, are covered with no copay and a coinsurance of at most 20%. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Advantage Care (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Advantage Care (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Advantage Care (HMO) plan, with no copay for days 1-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Under the Advantage Care (HMO) plan, acupuncture is covered with a $30 copay, up to 12 treatments per year. Over-the-counter items are covered, including nicotine replacement therapy and Naloxone, and the plan covers all drugs on the CMS OTC list. 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.
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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.
* 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.
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