A non-government entity
Perennial Advantage Premier (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Perennial Advantage Premier (HMO 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 I-SNP) in 2026, please refer to our full plan details page.
Perennial Advantage Premier (HMO I-SNP) is a HMO I-SNP 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 Premier (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:
Perennial Advantage Premier (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 Perennial Advantage Premier (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 Perennial Advantage Premier (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 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:
Sign up for Perennial Advantage Premier (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 Perennial Advantage Premier (HMO I-SNP) Medicare plan features an annual drug deductible of $400. 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 medications, standard pharmacy and mail-order copays are $10 for a 1-month supply, $20 for a 2-month supply, and $30 for a 3-month supply. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply, while Tier 4 non-preferred drugs carry a $95 copay for a 1-month supply, with both tiers offering proportional copays for longer-term fills. Specialty tier medications in Tier 5 require a 28% coinsurance for a 1-month supply through standard pharmacies or mail order.
Additional Benefits
The Perennial Advantage Premier (HMO I-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, home health care, and skilled nursing facility services. For inpatient hospital stays, members pay a 225 dollar daily copay for the first six days and no copay for days seven through ninety. Outpatient hospital services, specialist visits, and emergency care are also covered with predictable copays and no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage with no copay and no coinsurance up to a 2,100 dollar annual limit. Vision and hearing benefits feature no copays for routine exams, with allowances provided for eyeglasses and prescription hearing aids. Additionally, members can access over-the-counter items and home infusion services with no copay, while durable medical equipment and dialysis require a 20 percent coinsurance.
Inpatient Hospital See details
Perennial Advantage Premier (HMO I-SNP) covers inpatient hospital care with no coinsurance, requiring a $225 daily copay for days 1 to 6 and no copay for days 7 to 90 per stay. This benefit is partially covered, as upgrades for acute stays, and additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Perennial Advantage Premier (HMO I-SNP) covers outpatient hospital services with a $0 to $250 copay and no coinsurance, while outpatient observation services require a $100 copay and no coinsurance. Additionally, ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services are covered with no copay and 20% coinsurance.
Partial Hospitalization See details
Perennial Advantage Premier (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Perennial Advantage Premier (HMO I-SNP) plan, with prior authorization required for all ambulance services. Ground ambulance services require a $250 copay and no coinsurance, while air ambulance services carry a 20% coinsurance and no copay. Some transportation services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Perennial Advantage Premier (HMO I-SNP) 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 $20 to $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Perennial Advantage Premier (HMO I-SNP) covers primary care physician visits with no copay and no coinsurance, while specialist and mental health specialty visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, whereas psychiatric services require a 20% coinsurance with no copay, and chiropractic services are not covered in practice.
Preventive Services See details
Preventive Services are partially covered under Perennial Advantage Premier (HMO I-SNP) with no copay and no coinsurance for covered benefits like kidney disease education, fitness programs, and glaucoma screenings. However, the plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Perennial Advantage Premier (HMO I-SNP) with no copay for exams, though routine annual exams require a 20% coinsurance. OTC hearing aids and fitting evaluations are covered with no copay or coinsurance, while prescription hearing aids are partially covered with no copay or coinsurance up to $100 monthly, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Vision services are partially covered by Perennial Advantage Premier (HMO I-SNP) with no deductibles, no copays, and a 20% coinsurance for covered services. The plan covers one routine eye exam per year and eyeglasses up to a $100 monthly limit, but contact lenses and other eye exam services are not covered.
Dental Services See details
Dental Services are partially covered by Perennial Advantage Premier (HMO I-SNP), with other preventive dental services, maxillofacial prosthetics, and orthodontics not being covered. Medicare-covered dental services feature no copay and a 20% coinsurance, while other covered dental services have no copay and no coinsurance up to a $2,100 yearly limit.
Home Infusion bundled Services See details
Perennial Advantage Premier (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, have a coinsurance ranging from 0% to 20%, with insulin capped at a $35 copay.
Dialysis Services See details
Dialysis services are covered by Perennial Advantage Premier (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Perennial Advantage Premier (HMO I-SNP) covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. Diabetic equipment is partially covered with no copay, offering therapeutic shoes and inserts with no coinsurance to 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Perennial Advantage Premier (HMO I-SNP) partially covers diagnostic and radiological services with prior authorization required, featuring no copays and a 20% coinsurance for covered diagnostic procedures, diagnostic radiological services, and therapeutic radiological services. Outpatient X-ray services and lab services are not covered under this plan.
Home Health Services See details
Home Health Services are covered by Perennial Advantage Premier (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Perennial Advantage Premier (HMO I-SNP) covers some Cardiac Rehabilitation Services with no copay, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Perennial Advantage Premier (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because additional days beyond the standard Medicare-covered limit are not covered, but the plan does allow for admission without a prior three-day inpatient hospital stay.
Other Services See details
Other Services are partially covered by Perennial Advantage Premier (HMO I-SNP), featuring 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