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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 2026, 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 2026.
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 $3500.00 (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 $3500.00 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) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic medications are also highly affordable, requiring a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and specialty medications, the plan offers predictable cost-sharing options at standard pharmacies and mail-order services. Tier 3 preferred brand drugs carry a $45 copay for a one-month supply, while Tier 4 non-preferred drugs have a $95 copay per month. Specialty drugs in Tier 5 require a 25% coinsurance for a one-month supply, ensuring you only pay a portion of the cost for high-tier prescriptions.
Additional Benefits
The Perennial Advantage Premier (HMO-POS I-SNP) plan offers robust coverage with no copay and no coinsurance for primary care and specialist doctor visits, home health care, and skilled nursing facility stays. For inpatient hospital stays, members pay a daily copay of $225 for the first five days, followed by no copay for days six through ninety. Outpatient services feature copays ranging from no copay up to $250, while emergency room visits incur a $90 copay which is waived if admitted. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care covered with no copay and no coinsurance up to a $3,600 annual maximum. Routine hearing exams, vision exams, and eyeglasses are covered with no copay and a 20% coinsurance, with hearing aids covered up to $1,350 annually and eyeglasses up to a $275 limit. Additionally, members can take advantage of up to 24 free one-way transportation trips per year to health-related locations and select over-the-counter items with no copay.
Inpatient Hospital See details
Perennial Advantage Premier (HMO-POS I-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $225 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Prior authorization is required, and while acute care covers unlimited additional days, upgrades are not covered, and psychiatric care excludes additional days and non-Medicare-covered stays.
Outpatient Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers outpatient hospital services with no coinsurance and a copay of $0 to $250, plus observation services for a $100 copay per stay. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are covered with no copay and 20% coinsurance, though prior authorization is required for most of these services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Perennial Advantage Premier (HMO-POS I-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance, offering up to 24 one-way trips per year to any health-related location, though trips to plan-approved locations are not covered.
Emergency Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a $20 to $55 copay and no coinsurance. Both copays are waived if you are admitted to the hospital within three days, though worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Perennial Advantage Premier (HMO-POS I-SNP) offers primary care and specialist physician visits with no copay and no coinsurance, though chiropractic services are not covered in practice. Occupational, physical, and speech therapies require a $5 copay and no coinsurance, while mental health services carry a $25 copay with no coinsurance, and psychiatric services have no copay and a 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Perennial Advantage Premier (HMO-POS I-SNP) with no copay and no coinsurance for covered options like kidney disease education, in-home support, memory fitness, and glaucoma screenings. However, several sub-services are not covered, including the annual physical exam, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers routine hearing exams with no copay and a 20% coinsurance, plus fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,350 annual maximum, excluding inner, outer, and over-the-ear types, while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Perennial Advantage Premier (HMO-POS I-SNP) offers partially covered vision services with no copays, a 20% coinsurance, and no deductibles. One routine eye exam per year and eyeglasses are covered up to a $275 annual maximum, while contact lenses and other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by Perennial Advantage Premier (HMO-POS I-SNP), featuring Medicare-covered dental care with no copay and 20% coinsurance, as well as preventive and comprehensive services up to $3,600 annually with no copay and no coinsurance. However, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Perennial Advantage Premier (HMO-POS I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Perennial Advantage Premier (HMO-POS I-SNP) covers medical equipment with no copays, though coinsurance and prior authorization may apply for certain items. Durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance, while diabetic supplies have no coinsurance and diabetic therapeutic shoes or inserts range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Perennial Advantage Premier (HMO-POS I-SNP) partially covers diagnostic and radiological services with prior authorization required, offering no copayments. Covered diagnostic procedures, diagnostic radiological services, and therapeutic radiological services incur a 20% coinsurance, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Perennial Advantage Premier (HMO-POS I-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Perennial Advantage Premier (HMO-POS I-SNP) with no copay and no coinsurance, though prior authorization is required. The plan allows SNF admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Perennial Advantage Premier (HMO-POS I-SNP) provides partial coverage for other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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