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PruittHealth Premier D-SNP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PruittHealth Premier D-SNP (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PruittHealth Premier D-SNP (HMO D-SNP) in 2026, please refer to our full plan details page.
PruittHealth Premier D-SNP (HMO D-SNP) is a HMO D-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 D-SNP (HMO D-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 D-SNP (HMO D-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 D-SNP (HMO D-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 D-SNP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.80. 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 D-SNP (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out of pocket for your covered medications before the plan begins to pay its share. Detailed information regarding specific drug tiers, copayments, and coinsurance amounts is not available for this plan. As a Dual Eligible Special Needs Plan, your actual prescription costs and eligibility for financial assistance may vary based on your level of Medicaid support.
Additional Benefits
The PruittHealth Premier D-SNP (HMO D-SNP) offers strong core medical coverage with no copay for primary care doctor visits, home health services, and skilled nursing facility care. If you need specialized care, specialist visits require a $10 copay, while emergency room visits carry a $90 copay that is waived upon hospital admission. Outpatient hospital services, diagnostic tests, and durable medical equipment generally feature a 20% coinsurance with no copay. Beyond medical care, this plan provides valuable extra benefits including up to 80 one-way transportation trips per year to plan-approved locations with no copay. You can also take advantage of generous allowances, featuring up to $4,200 annually for dental care, a $4,620 annual allowance for prescription hearing aids, and up to $500 for eyewear with no copay. Furthermore, over-the-counter items, chronic illness meals, and covered preventive services are all provided with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered by PruittHealth Premier D-SNP (HMO D-SNP) with no copay, though Medicare-defined deductibles and coinsurance apply and prior authorization is required. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers outpatient hospital services with a 20% coinsurance and observation services with a $100 copay per stay. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by PruittHealth Premier D-SNP (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 80 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by PruittHealth Premier D-SNP (HMO D-SNP) with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within 3 days. Urgently needed services are covered with a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are not covered. Cost sharing for these services counts toward the plan-level deductible.
Primary Care See details
Primary care services under the PruittHealth Premier D-SNP (HMO D-SNP) include primary care doctor visits with no copay and no coinsurance, while specialist visits require a $10 copay and no coinsurance. Physical, occupational, and speech therapies have no copay and 20% coinsurance, mental health sessions require a $40 copay and no coinsurance, and routine chiropractic services are not covered.
Preventive Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers preventive services with no copay and no coinsurance, including Medicare-covered zero-dollar services, kidney disease education, and select additional benefits like a personal emergency response system and telemonitoring. However, preventive services are only partially covered because an annual physical exam, health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, enhanced disease management, home safety devices, and counseling are not covered.
Hearing Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers hearing services with no copay for exams and prescription hearing aids, featuring a 20% coinsurance for routine exams and no coinsurance for prescription aids. Hearing services are partially covered as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, though the plan offers a $4,620 annual allowance for covered prescription aids.
Vision Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers vision services, offering eye exams with no copay and a 20% coinsurance for routine exams, and glaucoma screenings with no copay. Covered eyewear, including contact lenses, eyeglasses, and upgrades, features no copay or coinsurance up to a $500 combined annual maximum.
Dental Services See details
PruittHealth Premier D-SNP (HMO D-SNP) provides partially covered dental services, featuring Medicare-covered dental with no copay and 20% coinsurance, plus other covered dental services up to a $4,200 annual maximum with no copay and no coinsurance. Other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PruittHealth Premier D-SNP (HMO D-SNP) with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance which counts toward the plan deductible.
Dialysis Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
PruittHealth Premier D-SNP (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes and inserts with no copay and a 20% coinsurance. This benefit is partially covered because diabetic supplies are not covered, and prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by PruittHealth Premier D-SNP (HMO D-SNP) with a 20% coinsurance and no copay, requiring prior authorization. Diagnostic procedures, radiological services, and outpatient X-rays are covered, but lab services are not covered.
Home Health Services See details
Home Health Services are covered by PruittHealth Premier D-SNP (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PruittHealth Premier D-SNP (HMO D-SNP) covers some cardiac rehabilitation services with no copay and prior authorization, but several key programs are not covered in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by PruittHealth Premier D-SNP (HMO D-SNP) with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by PruittHealth Premier D-SNP (HMO D-SNP), which offers over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered.
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