A non-government entity
eternalHealth Horizon (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for eternalHealth Horizon (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on eternalHealth Horizon (HMO) in 2025, please refer to our full plan details page.
eternalHealth Horizon (HMO) is a HMO plan offered by Eternal Health of Delaware, Inc. available for enrollment in 2025 to people living in Maricopa and Pima County. The overall rating for this plan is not yet available for 2025.
It's important to know that eternalHealth Horizon (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 eternalHealth Horizon (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 eternalHealth Horizon (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 $200.00 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 $3350.00 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 eternalHealth Horizon (HMO)
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 eternalHealth Horizon (HMO) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs at a standard pharmacy, you will pay a $5 copay for preferred generics and a $45 copay for standard generics. For brand name drugs, you will pay 28% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The eternalHealth Horizon (HMO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services and ambulance services have copays that vary by service. Primary care visits, hearing exams, and vision exams have set copays, and dental services are also covered. This plan provides coverage for home health services with no copay, as well as home infusion and dialysis services with coinsurance. Additionally, the plan includes coverage for medical equipment and diagnostic services with coinsurance or copays. Other covered services include OTC items and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 7 days of an inpatient stay, there is a $150 copay, and days 8-90 have no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $175, observation services with a $150 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services include individual and group sessions with a copay of $20. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the eternalHealth Horizon (HMO) plan, with a copay of $25.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the eternalHealth Horizon (HMO) plan. Ground and air ambulance services have a $250 copay, while transportation services to a plan-approved health-related location are covered with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $135 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $95 copay, and there is no coinsurance for any of these services.
Primary Care See details
The eternalHealth Horizon (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services, Occupational Therapy Services, Physical Therapy, and Speech-Language Pathology Services have a $20 copay; individual and group mental health and psychiatric sessions have a copay between $0 and $15; and Opioid Treatment Program Services have a $20 copay. Routine chiropractic care is not covered, and a doctor referral is required for Physician Specialist Services.
Preventive Services See details
The eternalHealth Horizon (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services. The plan also covers Personal Emergency Response Systems (PERS), In-Home Support Services, and Fitness Benefits. However, services such as Health Education, In-Home Safety Assessments, 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, 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 are covered, including routine hearing exams with a $20 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $595 and $895, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The eternalHealth Horizon (HMO) plan covers vision services, including eye exams with a $20 copay. Eyewear is covered with a combined maximum benefit of $200 every year, and contact lenses are covered.
Dental Services See details
Dental services are covered by the eternalHealth Horizon (HMO) plan, with a $30 copay for Medicare dental services. Other dental services have a maximum plan benefit of $3,500 per year, and include Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics.
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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the eternalHealth Horizon (HMO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the eternalHealth Horizon (HMO) plan. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $60, Diagnostic Radiological Services with a copay up to $170, and Therapeutic Radiological Services with a copay up to $60. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the eternalHealth Horizon (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services (Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services) are covered. Prior authorization is required, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the eternalHealth Horizon (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The eternalHealth Horizon (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $60.00 every three months, including nicotine replacement therapy and Naloxone, and also covers a meal benefit for chronic illness. Acupuncture, 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 are not covered.
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