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Perennial Advantage Premier (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Perennial Advantage Premier (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Perennial Advantage Premier (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
Perennial Advantage Premier (HMO-POS I-SNP) is a HMO-POS I-SNP 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 Premier (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Perennial Advantage Premier (HMO-POS 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 Perennial Advantage Premier (HMO-POS 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 Perennial Advantage Premier (HMO-POS 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 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 Premier (HMO-POS I-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For standard generics, you will pay a $10 copay at a standard pharmacy, and $45 copay for a standard generic. For preferred brand drugs, the copay is $95. Non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your covered drugs.
Additional Benefits
The Perennial Advantage Premier (HMO-POS I-SNP) plan offers a wide array of health benefits. You can expect to pay a $225 copay for inpatient hospital stays for the first 5 days, with no copay for days 6-90, and copays for outpatient services ranging from $0 to $250. Emergency services have a $90 copay, and primary care visits have a $20 copay. This plan also includes coverage for hearing, vision, and dental services, with varying coinsurance and maximum benefits. Additionally, it covers home health, diagnostic, and dialysis services, as well as medical equipment, with coinsurance applying to most of these services. The plan also offers transportation services, prescription hearing aids, and OTC items, providing a comprehensive package of healthcare coverage.
Inpatient Hospital See details
Inpatient Hospital benefits for Perennial Advantage Premier (HMO-POS I-SNP) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For the first 5 days, you will pay a $225 copay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Upgrades, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay 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, and Observation Services with a $100 copay. Ambulatory Surgical Center and Outpatient Substance Abuse Services are covered with 20% coinsurance, and Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground ambulance services with a $250 copay, and air ambulance services with 20% coinsurance. Transportation Services to any health-related location are covered for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan, with a $90 copay and no coinsurance. Urgently Needed Services are also covered, with a copay between $20 and $55 and no coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
Perennial Advantage Premier (HMO-POS I-SNP) covers primary care physician services, occupational therapy services with a $20 copay, 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, physical therapy and speech-language pathology services with a $20 copay, and additional telehealth benefits with a $0-$25 copay. Chiropractic Services are covered with 20% coinsurance for routine care, Other Health Care Professional and Psychiatric Services are covered with 20% coinsurance, and Opioid Treatment Program Services are covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, are covered by the Perennial Advantage Premier (HMO-POS I-SNP) plan, but the Annual Physical Exam is not covered. Additional preventive services are also covered, but Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of at most 20%, and routine hearing exams and fitting/evaluation for hearing aids are covered, each with one visit per year. Prescription hearing aids are covered with a maximum benefit of $1350 per year, and OTC hearing aids are also covered. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear, with a 20% coinsurance. Eyewear has a combined maximum benefit of $275.00 every year, while contact lenses are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services, but other dental services have a $3,000 maximum benefit per year. Oral exams are covered up to 2 visits per year, and dental x-rays are covered for 2 per year. Prophylaxis (cleaning) is covered for 2 visits per year, and fluoride treatment is covered every six months, with the number of visits limited to 1.
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 and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with coinsurance for Medicare-covered supplies, and Diabetic Equipment with coinsurance for Medicare-covered supplies and shoes/inserts. Durable Medical Equipment for use outside the home is not covered, and there is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all diagnostic and radiological services, but with coinsurance. Diagnostic Procedures/Tests, Diagnostic Radiological Services, and Therapeutic Radiological Services have a coinsurance of at most 20%, 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 Premier (HMO-POS I-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. The plan does not cover additional days beyond Medicare-covered SNF or non-Medicare-covered SNF stays.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, 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, and Self-Directed Personal Assistance Services. OTC items are covered as a supplemental benefit, including Nicotine Replacement Therapy (NRT) and Naloxone.
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