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eternalHealth Grand Give Back (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for eternalHealth Grand Give Back (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on eternalHealth Grand Give Back (HMO) in 2025, please refer to our full plan details page.
eternalHealth Grand Give Back (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 Grand Give Back (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 Grand Give Back (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 Grand Give Back (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. Additionally, this plan comes with a Part B Premium reduction of $80.00. You must continue to pay paying your reduced 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 $4550.00 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 Grand Give Back (HMO) plan has a $400 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, you'll pay a $5 copay at standard and mail order pharmacies. Standard generic drugs have a $45 copay, and preferred brand and non-preferred drugs have a 28% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The eternalHealth Grand Give Back (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a $325 copay for days 1-5 and no copay for days 6-90, along with outpatient services, emergency services, and ambulance services. This plan also provides coverage for primary care, preventive services, hearing, vision, and dental services, with varying copays for specific services, such as a $25 copay for hearing exams and a $30 copay for Medicare dental services. Additional benefits include home health services with no copay, and skilled nursing facility stays with no copay for days 1-20, and a $203 copay for days 21-100. The plan also offers coverage for acupuncture, over-the-counter items, and a meal benefit for chronic illnesses. However, it's important to note that some services may require prior authorization, and there are limitations on certain benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered under the eternalHealth Grand Give Back (HMO) plan. For days 1-5, the copay is $325, but there is no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $225, and observation services with a $185 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $20 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the eternalHealth Grand Give Back (HMO) plan. You will pay a $25 copay for this benefit.
Ambulance and Transportation Services See details
The eternalHealth Grand Give Back (HMO) plan covers ambulance services with a $270 copay for both ground and air ambulance services, and no coinsurance. Transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services are covered by the eternalHealth Grand Give Back (HMO) plan, with a $120 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $25, with no coinsurance, and Worldwide Emergency Services are covered with a $120 copay for Worldwide Emergency Coverage, a $40 copay for Worldwide Urgent Coverage, and a $125 copay for Worldwide Emergency Transportation, all with no coinsurance.
Primary Care See details
The eternalHealth Grand Give Back (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $15 copay, mental health specialty services with a copay between $0 and $20 depending on the service, other health care professional services with a copay between $0 and $15, psychiatric services with a copay between $0 and $20 depending on the service, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
The eternalHealth Grand Give Back (HMO) plan covers preventive services, including Medicare-covered services with no copay, as well as annual physical exams. Additional preventive services include therapeutic massage with a $20 copay, and fitness benefits. Some additional services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services are covered by the eternalHealth Grand Give Back (HMO) plan, including hearing exams with a $25 copay. Prescription Hearing Aids are covered with a copay between $595 and $895, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, nor are OTC hearing aids.
Vision Services See details
The eternalHealth Grand Give Back (HMO) plan covers vision services including eye exams, with a $25 copay. The plan also covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 per year, but upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $30 copay, and other dental services with a $3,000 maximum benefit per year. 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 and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered.
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, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the eternalHealth Grand Give Back (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by the eternalHealth Grand Give Back (HMO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetics/Medical Supplies and Diabetic Equipment have a 20% coinsurance for some services; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the eternalHealth Grand Give Back (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $60, while Diagnostic Radiological Services have a copay between $115 and $225, and Therapeutic Radiological Services have a copay of $60. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the eternalHealth Grand Give Back (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. This plan requires prior authorization for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the eternalHealth Grand Give Back (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The eternalHealth Grand Give Back (HMO) plan covers acupuncture with a $25 copay, and up to 20 treatments per year. Over-the-counter items are covered with a maximum of $70 every three months, and the plan also covers a meal benefit for chronic illnesses. However, services like Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several others are not covered.
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