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 2026, 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, Pima, Pinal, and Graham Counties. The overall rating for this plan is not yet available for 2026.
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:
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Drug Coverage
The eternalHealth Horizon (HMO) plan features an Enhanced Alternative drug benefit with a $200 annual prescription drug deductible. After meeting this deductible, you will pay a $5 copay for preferred generic drugs and a $47 copay for standard generic drugs at standard pharmacies or through standard mail. For higher-tier prescriptions, the plan charges a 35% coinsurance for preferred brand drugs and a 30% coinsurance for non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. Additionally, beneficiaries who qualify for the low-income subsidy will have no cost for their drug coverage.
Additional Benefits
The eternalHealth Horizon (HMO) plan offers robust medical coverage with copays ranging from no copay to $20 for primary care, specialist, and mental health visits. For hospital care, inpatient stays require a $180 daily copay for days 1 through 7 and no copay for days 8 through 90, while outpatient surgical center services feature no copay. Additionally, emergency room visits require a $135 copay, which is waived if you are admitted within 24 hours, and urgent care visits require no copay. In addition to core medical care, the plan provides valuable extra benefits including dental coverage up to a $3,000 annual maximum, a $200 annual allowance for eyewear, and routine hearing exams with a $20 copay. Members also receive up to 24 one-way transportation trips to approved health locations, a $70 quarterly over-the-counter reimbursement, and no copay for preventive services. Essential medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
eternalHealth Horizon (HMO) provides partially covered inpatient hospital benefits, which require a $180 daily copay for days 1 through 7 and no copay or coinsurance for days 8 through 90. While acute and psychiatric stays are covered, non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by eternalHealth Horizon (HMO) with no coinsurance, featuring no copay for ambulatory surgical center services and copays ranging from $0 to $175 for outpatient hospital services. Patients will also pay a $150 copay per stay for observation services, a $20 copay for outpatient substance abuse sessions, and no copay or deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the eternalHealth Horizon (HMO) plan, requiring a $25.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by eternalHealth Horizon (HMO), requiring a $250 copay and no coinsurance for ground and air ambulance services. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by eternalHealth Horizon (HMO) with a $135 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with no coinsurance and copays up to $250.
Primary Care See details
Primary Care benefits are partially covered by eternalHealth Horizon (HMO), featuring no coinsurance and copays ranging from no copay up to $20.00 for covered services such as primary care, specialist, therapy, and mental health visits. However, podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are covered by eternalHealth Horizon (HMO), featuring Medicare-covered zero-dollar preventive services with no copay or coinsurance, as well as annual physical exams. Additional preventive services are partially covered, offering personal emergency response systems, in-home support, and fitness benefits, while other options like health education, alternative therapies, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by eternalHealth Horizon (HMO), including one routine hearing exam per year for a $20 copay and no coinsurance. Prescription hearing aids are covered up to two per year with a copay of $595 to $895 and no coinsurance, but OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
eternalHealth Horizon (HMO) provides partially covered vision services, which include one routine eye exam per year for a $20 copay and no coinsurance. The plan also features a $200 annual allowance for contacts and eyeglasses with no copay or coinsurance, though eyewear upgrades are not covered.
Dental Services See details
eternalHealth Horizon (HMO) partially covers dental services up to a $3,000 annual maximum, though adjunctive general services and orthodontics are not covered. Medicare-covered dental services are available with a $20 copay and no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by eternalHealth Horizon (HMO) with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by eternalHealth Horizon (HMO) with a 20% coinsurance and no copay.
Medical Equipment See details
eternalHealth Horizon (HMO) covers medical equipment, prosthetics, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and coinsurance ranging from no coinsurance to 20%, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by eternalHealth Horizon (HMO) with prior authorization, though lab services and outpatient x-ray services are not covered. Covered diagnostic procedures and tests range from no copay to a $60 copay, diagnostic radiological services range from no copay to a $170 copay, and therapeutic radiological services require a $60 copay, all with no coinsurance.
Home Health Services See details
Home health services are covered under the eternalHealth Horizon (HMO) plan, providing essential in-home medical care. Specific copayment and coinsurance cost details are not specified in this plan benefit overview.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the eternalHealth Horizon (HMO) plan, as all related sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD)—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
eternalHealth Horizon (HMO) partially covers Skilled Nursing Facility (SNF) services, though additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, and there is no coinsurance, with no copay for days 1 through 20 and a $203 daily copay for days 21 through 100.
Other Services See details
eternalHealth Horizon (HMO) partially covers Other Services, which includes a meal benefit for chronic illnesses and a $70 quarterly over-the-counter reimbursement at no copay or coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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