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PruittHealth Premier (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PruittHealth Premier (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PruittHealth Premier (HMO I-SNP) in 2025, please refer to our full plan details page.
PruittHealth Premier (HMO I-SNP) is a HMO I-SNP plan offered by UNICO Services, Inc. available for enrollment in 2025 to people living in Georgia (partial). This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that PruittHealth Premier (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PruittHealth Premier (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PruittHealth Premier (HMO I-SNP).
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 PruittHealth Premier (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $590.00 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 $9350.00 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 PruittHealth Premier (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, the plan covers drugs, but the specific costs for each tier and pharmacy type are not provided in this summary. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $40.
Additional Benefits
The PruittHealth Premier (HMO I-SNP) plan offers a range of benefits, including coverage for outpatient services with varying coinsurance and copays, as well as coverage for ambulance, emergency, and primary care services. Vision services include eye exams and eyewear coverage, while dental services are partially covered. This plan also covers hearing exams and hearing aids, with a maximum benefit for hearing aids every two years. Additionally, the plan provides home health services with no copay, along with medical equipment, home infusion, dialysis, and diagnostic services with coinsurance. The plan provides a $45 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the PruittHealth Premier (HMO I-SNP) plan, but the specific cost-sharing details like coinsurance and deductible are not provided. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with 20% coinsurance, and Observation Services with a $100 copay per stay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with coinsurance of 20% for Individual and Group Sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PruittHealth Premier (HMO I-SNP) plan, 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 PruittHealth Premier (HMO I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the PruittHealth Premier (HMO I-SNP) plan, with a $90 copay and no coinsurance. Urgently Needed Services are covered with 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The PruittHealth Premier (HMO I-SNP) plan covers primary care services, including primary care physician services and chiropractic services with a 20% coinsurance and a $30 copay for routine care, which is limited to 12 visits per year, and occupational therapy services with 5% coinsurance. The plan also covers physician specialist services with a $35 copay, mental health specialty services with 20% coinsurance for individual and group sessions, podiatry services with 20% coinsurance for routine foot care (limited to 6 visits per year), other health care professional services with 20% coinsurance, psychiatric services with 20% coinsurance for individual and group sessions, physical therapy and speech-language pathology services with 5% coinsurance, and additional telehealth benefits with 0%-20% coinsurance.
Preventive Services See details
Preventive Services are covered, but 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 benefit, 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 modifications, and counseling services are not covered. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20%, fitting/evaluation for hearing aids with no coinsurance, and prescription hearing aids (all types) with a maximum plan benefit coverage of $4,000 every two years. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance, and coverage for eyewear with a combined maximum of $300 per year. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are partially covered by the PruittHealth Premier (HMO I-SNP) plan. Medicare dental services are covered with a 20% coinsurance, while 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, you will have a $35 copay, and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PruittHealth Premier (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. For DME and Diabetic Supplies, you pay 20% coinsurance with no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the PruittHealth Premier (HMO I-SNP) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered; all services require prior authorization.
Home Health Services See details
Home Health Services are covered by the PruittHealth Premier (HMO I-SNP) plan with no copay and no coinsurance, but 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 covered, but the specific services of 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 are not covered. Prior authorization is required, and coinsurance information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and cost sharing is charged on the day of discharge.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, but Acupuncture, 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. The plan provides $45.00 per month for OTC items.
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