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Perennial Advantage Freedom (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Perennial Advantage Freedom (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Perennial Advantage Freedom (HMO-POS) in 2025, please refer to our full plan details page.
Perennial Advantage Freedom (HMO-POS) is a HMO-POS plan offered by Perennial Consortium, LLC available for enrollment in 2025 to people living in Colorado (partial). The overall rating for this plan is not yet available for 2025.
It's important to know that Perennial Advantage Freedom (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Perennial Advantage Freedom (HMO-POS).
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 Perennial Advantage Freedom (HMO-POS), 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 combined Maximum Out-Of-Pocket cost of $3900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Perennial Advantage Freedom (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies based on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at standard and mail-order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Perennial Advantage Freedom (HMO-POS) plan offers a range of benefits with varying cost-sharing. This plan covers inpatient hospital stays with a copay, and outpatient services with copays or coinsurance. It also includes coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, and dental services, with specific copays, coinsurance, and annual maximums. Additional benefits include home health services with no copay, home infusion, dialysis services, and durable medical equipment with coinsurance. The plan also covers certain prescription hearing aids, and includes an over-the-counter benefit, but excludes many other services such as worldwide emergency services, and services in an intermediate care facility.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $225 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, but upgrades are not. Non-Medicare-covered stays for Inpatient Hospital-Acute are covered, but additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $250, 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. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization, and has a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Perennial Advantage Freedom (HMO-POS) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are covered, with up to 24 one-way trips per year via rideshare services, bus/subway, medical transport, and other modes of transportation.
Emergency Services See details
Emergency Services are covered by the Perennial Advantage Freedom (HMO-POS) plan, with a $90 copay and no coinsurance. Urgently Needed Services are covered with a copay between $20 and $55 and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Perennial Advantage Freedom (HMO-POS) plan covers a variety of primary care services, including chiropractic services with 20% coinsurance, routine chiropractic care with a $35 copay, and occupational therapy services with a $20 copay. Other covered services include physician specialist services with a $20 copay, mental health specialty services with a $25 copay for individual and group sessions, podiatry services with a $35 copay for routine foot care (limited to 6 visits per year), and physical therapy and speech-language pathology services with a $20 copay. Additional telehealth benefits are covered with a copay between $0 and $25.
Preventive Services See details
The Perennial Advantage Freedom (HMO-POS) plan covers various preventive services, including Medicare-covered preventive services, with no copay. Additional preventive services are partially covered, but the plan does not cover 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 benefits, 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. The plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and In-Home Support Services.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered up to a maximum of $1350 per year, and OTC hearing aids are covered with no coinsurance. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams with 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with 20% coinsurance, and contact lenses are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance after prior authorization, and other dental services with a $2,000 annual maximum. Oral exams are covered for 2 visits per year, and dental x-rays are covered for 2 per year. Prophylaxis (cleaning) is covered for 2 visits per year, while fluoride treatment is covered every six months. Orthodontic Services are covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Perennial Advantage Freedom (HMO-POS) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The Perennial Advantage Freedom (HMO-POS) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires authorization, but does not cover DME for use outside the home. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Perennial Advantage Freedom (HMO-POS) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have at most 20% coinsurance, while Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Perennial Advantage Freedom (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Perennial Advantage Freedom (HMO-POS) plan, but require prior authorization. The plan follows Original Medicare's cost sharing for tier 1 SNF services, but additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services covers Over-the-Counter (OTC) Items, including Nicotine Replacement Therapy (NRT) and Naloxone, with no copay or coinsurance, but does not cover 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, or Self-Directed Personal Assistance Services.
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