A non-government entity
PruittHealth Premier Advantage (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PruittHealth Premier Advantage (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 Advantage (HMO I-SNP) in 2026, please refer to our full plan details page.
PruittHealth Premier Advantage (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 Advantage (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 Advantage (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 Advantage (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 Advantage (HMO I-SNP), 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 $5900.00 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:
Sign up for PruittHealth Premier Advantage (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PruittHealth Premier Advantage (HMO I-SNP) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no out-of-pocket deductible to meet. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic drugs, copays are highly affordable at just $7 for a one-month supply, $14 for a two-month supply, and $21 for a three-month supply. Brand-name and specialty medications are structured across higher tiers, with Tier 3 preferred brand drugs requiring a $45 copay for a one-month supply. Tier 4 non-preferred drugs carry a $95 copay for a one-month supply, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. These predictable copayments and coinsurance rates apply to both standard retail pharmacy purchases and standard mail-order deliveries.
Additional Benefits
The PruittHealth Premier Advantage (HMO I-SNP) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits, home health services, and skilled nursing facility stays. For inpatient hospital care, members pay a daily copay of $311 for days one through seven, followed by no copay for days eight through 90. Outpatient hospital services require copays ranging from $40 to $298, while emergency room visits carry a $90 copay that is waived upon hospital admission. Specialist visits require copays between $10 and $30, while preventive care is covered with no copay. The plan also features valuable supplemental benefits, including dental care and prescription hearing aids with no copay up to a $2,500 limit, alongside eyewear covered with no copay up to a $500 annual maximum. Additionally, members benefit from over-the-counter items and up to 48 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by PruittHealth Premier Advantage (HMO I-SNP) with no coinsurance, requiring a $311 daily copay for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by PruittHealth Premier Advantage (HMO I-SNP), featuring no coinsurance and copays ranging from $40 to $298 for outpatient hospital visits, $100 per stay for observation, and $298 for ambulatory surgical center services. Outpatient substance abuse and blood services are covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
PruittHealth Premier Advantage (HMO I-SNP) covers partial hospitalization services with an $85.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PruittHealth Premier Advantage (HMO I-SNP) covers ground ambulance services with a $285 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under PruittHealth Premier Advantage (HMO I-SNP) are covered with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services are covered with a $35 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are not covered.
Primary Care See details
PruittHealth Premier Advantage (HMO I-SNP) covers primary care and opioid treatment services with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $10.00 to $30.00 with no coinsurance. Chiropractic services are partially covered because other chiropractic services are not covered, and some benefits require prior authorization.
Preventive Services See details
Preventive services are partially covered by PruittHealth Premier Advantage (HMO I-SNP) with no copay and no coinsurance for covered benefits, which include Medicare-covered preventive care, kidney disease education, in-home support, and memory fitness. However, an annual physical exam and several supplemental benefits—such as health education, in-home safety assessments, and personal emergency response systems—are not covered.
Hearing Services See details
PruittHealth Premier Advantage (HMO I-SNP) covers hearing exams with no copay, though routine annual exams require a 20% coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,500 allowance every two years, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by PruittHealth Premier Advantage (HMO I-SNP), featuring routine eye exams and glaucoma testing with a $10.00 copay, no coinsurance, and no deductible. Eyewear, including contacts and eyeglasses, is covered with no copay, no coinsurance, and no deductible up to a $500 annual maximum limit.
Dental Services See details
PruittHealth Premier Advantage (HMO I-SNP) offers partially covered dental services with no copay and no coinsurance up to a $2,500 annual maximum. Covered services include exams, cleanings, and restorative care, but other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PruittHealth Premier Advantage (HMO I-SNP) with no copay, though prior authorization is required. Associated 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.
Dialysis Services See details
PruittHealth Premier Advantage (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
PruittHealth Premier Advantage (HMO I-SNP) partially covers medical equipment, providing durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Covered diabetic equipment features no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PruittHealth Premier Advantage (HMO I-SNP) covers diagnostic and radiological services with prior authorization, though lab services are not covered. Diagnostic procedures carry a $95 copay with no coinsurance, while outpatient x-rays require a $15 copay, diagnostic radiological services have a $225 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
PruittHealth Premier Advantage (HMO I-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by PruittHealth Premier Advantage (HMO I-SNP) with no coinsurance, although prior authorization is required. However, some services are not covered in practice, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PruittHealth Premier Advantage (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, additional SNF days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by PruittHealth Premier Advantage (HMO I-SNP), which offers over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved