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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 2026, 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 2026.
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 $25.40. 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 $615.00 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 $9250.00 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) Medicare Advantage plan features an annual prescription drug deductible of $615. Before the plan begins to cover the cost of your medications, you must meet this deductible amount. Detailed information regarding specific drug tiers, copays, and coinsurance is currently unavailable for this plan. To determine how your specific prescriptions are covered under this plan, it is recommended to review the plan's comprehensive formulary.
Additional Benefits
The PruittHealth Premier (HMO I-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, home health care, and skilled nursing facility stays. Specialist visits require a $35 copay, while emergency room services have a $90 copay. For inpatient hospital stays, there is no copay or coinsurance, though Medicare-defined deductibles apply, and outpatient services generally carry a 20% coinsurance with no copay. This plan also includes valuable extra benefits, such as up to 24 one-way transportation trips per year and an over-the-counter allowance of $55 per month with no copay. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, alongside generous allowances for eyewear and hearing aids. Medicare-covered dental services, diagnostic tests, and durable medical equipment are also available, typically requiring a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by PruittHealth Premier (HMO I-SNP) with no copay and no coinsurance, though prior authorization and Medicare-defined deductibles apply. This benefit does not cover additional hospital days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
PruittHealth Premier (HMO I-SNP) covers outpatient hospital services with a 20% coinsurance and no copay, and observation services with a $100 copay per stay and no coinsurance. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are all covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by PruittHealth Premier (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PruittHealth Premier (HMO I-SNP) covers ambulance services with a 20% coinsurance and no copay for both ground and air transportation. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by PruittHealth Premier (HMO I-SNP) with a $90 copay and no coinsurance, while urgently needed services require a 20% coinsurance (up to $40) and no copay, with both cost shares counting toward the plan-level deductible. These fees are waived if you are admitted to the hospital within three days, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Primary care benefits under PruittHealth Premier (HMO I-SNP) include primary care, therapy, and opioid treatment with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Mental health, psychiatric, and podiatry services are covered with no copay and 20% coinsurance, while chiropractic services are partially covered with routine and other chiropractic care not covered.
Preventive Services See details
Preventive services are partially covered under the PruittHealth Premier (HMO I-SNP) plan with no copay and no coinsurance for covered care such as kidney disease education and in-home support. Several sub-services are not covered under this plan, including annual physical exams, fitness benefits, health education, and home safety assessments.
Hearing Services See details
PruittHealth Premier (HMO I-SNP) covers routine hearing exams with no copay and a 20% coinsurance, alongside hearing aid fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $5,000 maximum every two years, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription devices are not covered.
Vision Services See details
Vision services covered by PruittHealth Premier (HMO I-SNP) include annual routine eye exams with no copay, 20% coinsurance, and no deductible, alongside yearly glaucoma testing. Eyewear is also covered with no copay, no coinsurance, and no deductible up to a $300 annual combined maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by PruittHealth Premier (HMO I-SNP), which covers Medicare-covered dental services with no copay and a 20% coinsurance, subject to prior authorization. Other dental services, including preventive care like cleanings and exams, as well as comprehensive treatments like orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PruittHealth Premier (HMO I-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the PruittHealth Premier (HMO I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the PruittHealth Premier (HMO I-SNP) plan with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
PruittHealth Premier (HMO I-SNP) partially covers diagnostic and radiological services, with prior authorization required. Covered services—including diagnostic procedures, outpatient X-rays, and diagnostic and therapeutic radiological services—carry a 20% coinsurance and no copay, while lab services are not covered.
Home Health Services See details
PruittHealth Premier (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PruittHealth Premier (HMO I-SNP) with no copay, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
PruittHealth Premier (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Standard SNF stays are covered, though additional days beyond Medicare-covered days are not covered, and cost sharing is charged on the day of discharge.
Other Services See details
PruittHealth Premier (HMO I-SNP) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance for up to $55 per month via reimbursement. Additional services in this category, including acupuncture and meal benefits, are not covered.
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