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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 2026, 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 2026.
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.
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 $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) Medicare plan offers an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, you will pay a fixed copay or coinsurance for your prescriptions at standard pharmacies or through standard mail-order services. For a 30-day supply, this includes a 10 dollar copay for preferred generics, a 45 dollar copay for standard generics, a 95 dollar copay for preferred brands, and a 33 percent coinsurance for non-preferred drugs. Once your yearly out-of-pocket drug costs reach 2100 dollars, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy can receive extra help to reduce their Part D premium to no cost.
Additional Benefits
The Advantage Care (HMO) plan offers comprehensive healthcare coverage with many essential services requiring no copayments. For instance, members pay no copay and no coinsurance for acute inpatient hospital stays, skilled nursing facility care up to 100 days, and primary care telehealth visits. Outpatient hospital services feature a copay ranging from no copay up to $225 with no coinsurance, while emergency room visits require a $90 copay and urgent care requires a $40 copay. For specialized care, services like dialysis, diagnostic radiology, and durable medical equipment generally require a 20% coinsurance and no copay. The plan also includes valuable supplemental benefits, such as up to 24 free one-way transportation trips per year and annual vision exams. Dental care is largely covered with no copay or coinsurance, and eyewear is covered up to $225 annually with a 20% coinsurance and no deductible.
Inpatient Hospital See details
Advantage Care (HMO) inpatient hospital benefits are partially covered, featuring no coinsurance for stays and no copay for acute care, though psychiatric stays require a $100 copay for days 4 through 10. Upgrades for acute stays, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Advantage Care (HMO) covers outpatient services, featuring a copay ranging from no copay up to $225 with no coinsurance for outpatient hospital services, and a $100 copay per stay with no coinsurance for observation services. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are covered with a 20% coinsurance and no copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Advantage Care (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Advantage Care (HMO), requiring a $125 copay and no coinsurance for ground services and a 20% coinsurance and no copay for air services, both subject to prior authorization. Transportation benefits are partially covered, excluding plan-approved health-related locations but providing up to 24 one-way trips per year to any health-related location with no copay or coinsurance.
Emergency Services See details
Advantage Care (HMO) partially covers emergency services, offering emergency services with a $90 copay and no coinsurance and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Advantage Care (HMO) provides primary care benefits, including telehealth with no copay and no coinsurance; however, for mental health specialty services, some services are covered but individual and group sessions are not covered. Most other covered services, including podiatry, psychiatric, and other professional care, require a 20% coinsurance and no copay, while routine chiropractic care has a 20% coinsurance and a $30 copay.
Preventive Services See details
Advantage Care (HMO) partially covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar services, kidney disease education, and select screenings. Sub-services that are not covered under this benefit include annual physical exams, fitness benefits, health education, weight management programs, and home safety modifications.
Hearing Services See details
Hearing services are partially covered by Advantage Care (HMO), which provides coverage for OTC hearing aids. While some hearing exam services are covered with a coinsurance of up to 20%, routine hearing exams, fitting evaluations, and all prescription hearing aids are not covered in practice.
Vision Services See details
Vision services are covered by Advantage Care (HMO), offering one routine eye exam per year and eyewear with a 20% coinsurance and no copay. This coverage features no deductible and includes a combined maximum benefit of $225 annually for eyewear.
Dental Services See details
Dental services are partially covered by Advantage Care (HMO), excluding maxillofacial prosthetics and orthodontics. Medicare-covered dental services require a 20% coinsurance and no copay, while other covered services have no copay or coinsurance, with a $3,000 annual maximum on orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Advantage Care (HMO), with prior authorization and step therapy required for certain services. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance up to 20%, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by Advantage Care (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is partially covered by Advantage Care (HMO), as diabetic supplies are not covered. Covered items—including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts—require no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under Advantage Care (HMO) with no copay and a 20% coinsurance, though prior authorization is required. Covered benefits include diagnostic procedures, diagnostic radiological services, and therapeutic radiological services, while lab services and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Advantage Care (HMO) plan, with prior authorization required before receiving care. Specific copayment and coinsurance details for these services are not specified in this benefit summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Advantage Care (HMO), and because none of the sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered, there are no copays or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Advantage Care (HMO) with prior authorization, featuring no copay and no coinsurance for days 1 through 100. However, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Advantage Care (HMO) partially covers Other Services, providing acupuncture for up to 12 treatments per year with a $30 copay and no coinsurance, as well as over-the-counter items. Meal benefits and highly integrated services for dual-eligible SNPs are not covered under this plan.
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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.
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