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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 2025, 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 2025.
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 $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 D-SNP (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs according to the plan's formulary, until your total drug costs reach $2000. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $40 per month for Part D.
Additional Benefits
The PruittHealth Premier D-SNP (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying cost-sharing. You can expect to pay coinsurance for services like outpatient hospital, partial hospitalization, and ambulance services. The plan also covers primary care, hearing, vision, and dental services, with specific copays and coinsurance amounts. Additional benefits include home health services with no copay and no coinsurance, and coverage for medical equipment and diagnostic services with a coinsurance. The plan also provides coverage for emergency services, and transportation to health-related locations. However, some services like certain preventive services and private duty nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare-covered stays, and upgrades for both are not covered. The plan requires prior authorization and the cost sharing details are not provided.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with 20% coinsurance, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with 20% coinsurance, and Outpatient Substance Abuse Services with 20% coinsurance for both individual and group sessions; however, Outpatient Blood Services are not covered. Prior authorization is required for all services.
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, including ground and air ambulance services, are covered by the PruittHealth Premier D-SNP (HMO D-SNP) plan, with no copay and 20% coinsurance. The plan also covers transportation services to plan-approved health-related locations, with a maximum of 80 one-way trips per year, but does not cover transportation services to any health-related location.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the PruittHealth Premier D-SNP (HMO D-SNP) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance; worldwide emergency services are not covered.
Primary Care See details
Primary Care, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, are covered. Chiropractic Services have a 20% coinsurance, and Routine Chiropractic Care has a $30 copay for up to 12 visits per year. Individual and Group Sessions for Mental Health and Psychiatric Services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance, and Additional Telehealth Benefits have a 0-20% coinsurance.
Preventive Services See details
Preventive Services are covered, but Annual Physical Exams, Health Education, In-Home Safety Assessment, 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, and Enhanced Disease Management are not covered. Personal Emergency Response System (PERS), In-Home Support Services, Fitness Benefit, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing services are covered, including hearing exams and prescription hearing aids. Routine hearing exams are covered with a 20% coinsurance, and fitting/evaluation for hearing aids has no coinsurance. Prescription hearing aids have a maximum plan benefit of $2550 per year, and some prescription hearing aid types are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and eyewear with a combined maximum of $500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare dental services with 20% coinsurance, other dental services with a $4,200 annual maximum, oral exams (2 visits per year), dental x-rays (2 per year), other diagnostic dental services, prophylaxis cleaning (2 per year), fluoride treatment (1 every six months), restorative services (1 visit), adjunctive general services (1 visit), endodontics (1 visit), periodontics (1 visit), prosthodontics, removable (1 visit), implant services, prosthodontics, fixed (1 visit), and oral and maxillofacial surgery (1 visit), while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the PruittHealth Premier D-SNP (HMO D-SNP) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under this plan, with no copay for all diagnostic and radiological services. 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.
Home Health Services See details
Home Health Services are covered 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 not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required and coinsurance applies, but specific coinsurance details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days or non-Medicare-covered stays. Prior authorization is required, and the plan uses the Medicare-defined cost share for tier 1.
Other Services See details
Under the PruittHealth Premier D-SNP (HMO D-SNP) plan, acupuncture, 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 offers Over-the-Counter (OTC) Items and a Meal Benefit for a chronic illness.
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