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Perennial Advantage Freedom (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Perennial Advantage Freedom (HMO). 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) in 2026, please refer to our full plan details page.
Perennial Advantage Freedom (HMO) is a HMO plan offered by Perennial Consortium, LLC available for enrollment in 2026 to people living in Pennsylvania (partial). The overall rating for this plan is not yet available for 2026.
It's important to know that Perennial Advantage Freedom (HMO) 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).
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), 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 a $400.00 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 $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:
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Drug Coverage
The Perennial Advantage Freedom (HMO) prescription drug plan has an annual drug deductible of $400. Tier 1 preferred generic drugs are covered with no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. For Tier 2 generic medications, you will pay a copay of $10 for a one-month supply, $20 for a two-month supply, or $30 for a three-month supply. Tier 3 preferred brand drugs require a copay of $45 for a one-month supply, $90 for a two-month supply, and $135 for a three-month supply. Tier 4 non-preferred drugs have copays ranging from $95 for a one-month supply to $285 for a three-month supply. Finally, Tier 5 specialty drugs require a 28% coinsurance for a one-month supply through standard pharmacies and mail order services.
Additional Benefits
The Perennial Advantage Freedom (HMO) plan provides coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, home health, and skilled nursing facility stays. Specialist visits require a $25 copay, while inpatient hospital stays have a $225 daily copay for the first six days and no copay for days seven through ninety. Emergency room visits incur a $90 copay, which is waived if you are admitted, and ground ambulance services require a $250 copay. For extra health benefits, this plan offers preventive and comprehensive dental care with no copay and no coinsurance up to a $2,100 annual limit. Vision services and routine hearing exams feature no copay and a 20% coinsurance, while hearing aids are covered with no copay up to a $100 monthly limit. Additionally, durable medical equipment, diagnostic services, and dialysis are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Perennial Advantage Freedom (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as acute hospital upgrades, additional psychiatric days, and psychiatric non-Medicare-covered stays are not covered.
Outpatient Services See details
Perennial Advantage Freedom (HMO) covers outpatient hospital services with no coinsurance and a $0 to $250 copay, and observation services with a $100 copay per stay and no coinsurance. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are also covered with no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Perennial Advantage Freedom (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive this coverage.
Ambulance and Transportation Services See details
Perennial Advantage Freedom (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Perennial Advantage Freedom (HMO) covers emergency services 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 copay of $20 to $50 and no coinsurance, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Perennial Advantage Freedom (HMO) offers primary care visits and opioid treatment with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies have a $20 copay and no coinsurance, psychiatric care has no copay and 20% coinsurance, and podiatry has a $35 copay and no coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by Perennial Advantage Freedom (HMO) with no copay and no coinsurance for covered options like kidney disease education, telemonitoring, and fitness benefits. However, an annual physical exam and supplemental services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Perennial Advantage Freedom (HMO) covers hearing services, offering annual routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Over-the-counter and prescription hearing aids are covered with no copay and no coinsurance up to a $100 monthly limit, though prescription aids are only partially covered since inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Perennial Advantage Freedom (HMO) vision services are partially covered with no copay and a 20% coinsurance, featuring no deductible and a $100 monthly maximum for eyewear. This benefit covers one routine eye exam per year and eyeglasses, while contact lenses and other eye exams are not covered.
Dental Services See details
Perennial Advantage Freedom (HMO) partially covers dental services, providing Medicare-covered dental with no copay and 20% coinsurance, alongside preventive and comprehensive dental care with no copay, no coinsurance, and a $2,100 annual maximum. Other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Perennial Advantage Freedom (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs are subject to no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Perennial Advantage Freedom (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Perennial Advantage Freedom (HMO) partially covers Medical Equipment with no copays, though diabetic supplies are not covered. Covered durable medical equipment, prosthetic devices, and medical supplies require prior authorization and a 20% coinsurance, while diabetic therapeutic shoes and inserts range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Perennial Advantage Freedom (HMO) with no copay and a 20% coinsurance, and prior authorization is required. Lab services and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Home Health Services are covered by Perennial Advantage Freedom (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Perennial Advantage Freedom (HMO) with no copay, though prior authorization is required and specific services like cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Perennial Advantage Freedom (HMO) covers Skilled Nursing Facility (SNF) services 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 days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Perennial Advantage Freedom (HMO) provides partial coverage for other services, featuring no copay and no coinsurance for over-the-counter (OTC) items and chronic illness meal benefits. Acupuncture is not covered under this plan.
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