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eternalHealth + Fry's Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for eternalHealth + Fry's Medicare Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on eternalHealth + Fry's Medicare Advantage (HMO) in 2026, please refer to our full plan details page.
eternalHealth + Fry's Medicare Advantage (HMO) is a HMO plan offered by Eternal Health of Delaware, Inc. available for enrollment in 2026 to people living in Maricopa, Pinal, Pima, and Graham counties. The overall rating for this plan is not yet available for 2026.
It's important to know that eternalHealth + Fry's Medicare Advantage (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 + Fry's Medicare Advantage (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 + Fry's Medicare Advantage (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 $250.00 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 $4350.00 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 + Fry's Medicare Advantage (HMO) plan features an Enhanced Alternative drug benefit with a $250 prescription drug deductible. After meeting this deductible, your costs at standard pharmacies or standard mail services include a $5 copay for Tier 1 preferred generics and a $47 copay for Tier 2 standard generics. For higher-tier medications, you will pay a coinsurance of 35% for Tier 3 preferred brands and 30% for Tier 4 non-preferred drugs. These initial coverage rates apply until your total yearly out-of-pocket drug costs reach $2,100, at which point you enter the catastrophic coverage phase and have no copay for covered Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy, also known as Extra Help, will enjoy no costs for their Part D coverage.
Additional Benefits
The eternalHealth + Fry's Medicare Advantage (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays for preventive care, annual physicals, and lab services. For inpatient hospital stays, members pay a $200 daily copay for the first seven days and no copay for days eight through 90, with no coinsurance. Primary care, specialist, and mental health visits are highly affordable, ranging from no copay up to a $30 copay with no coinsurance. This plan also provides valuable supplemental benefits, including a $1,000 annual limit for dental care, a $200 yearly eyewear allowance, and routine hearing exams for a $30 copay. Members also benefit from a $125 quarterly over-the-counter item reimbursement and up to 36 one-way transportation trips to plan-approved locations with no copays. While medical equipment and dialysis require a 20% coinsurance, most other diagnostic and outpatient services feature flat copays and no coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by eternalHealth + Fry's Medicare Advantage (HMO), with a $200 daily copay for days 1 through 7, no copay for days 8 through 90, and no coinsurance. Prior authorization is required, and exclusions apply as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
eternalHealth + Fry's Medicare Advantage (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center services with no copay and outpatient substance abuse sessions for a $30 copay. Outpatient hospital services require a copay of $0 to $175, observation services carry a $150 copay per stay, and blood services have no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the eternalHealth + Fry's Medicare Advantage (HMO) plan with a copay ranging from $20.00 to $25.00 and no coinsurance.
Ambulance and Transportation Services See details
eternalHealth + Fry's Medicare Advantage (HMO) partially covers ambulance and transportation services, with ground and air ambulance services requiring a $250 copay and no coinsurance. While the plan covers up to 36 one-way trips per year to plan-approved health-related locations, transportation to any health-related location is not covered.
Emergency Services See details
eternalHealth + Fry's Medicare Advantage (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed and worldwide emergency services are also covered with no coinsurance, featuring copays ranging from no copay up to $25 for urgent care and up to $250 for worldwide emergency transportation.
Primary Care See details
eternalHealth + Fry's Medicare Advantage (HMO) covers primary care, specialist, telehealth, therapy, and mental health services with copays ranging from no copay up to $30 and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance, while routine chiropractic care and podiatry services are not covered.
Preventive Services See details
eternalHealth + Fry's Medicare Advantage (HMO) covers preventive services with no copay or coinsurance for Medicare-covered zero-dollar preventive care, annual physical exams, and kidney disease education. While select additional benefits like fitness programs, nutritional counseling, and alternative therapies are covered, other services including health education, weight management, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by eternalHealth + Fry's Medicare Advantage (HMO), featuring routine hearing exams for a $30 copay and no coinsurance, alongside fitting evaluations. Covered prescription hearing aids carry a copay between $595 and $895 with no coinsurance for up to two devices per year, though over-the-counter (OTC) hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
eternalHealth + Fry's Medicare Advantage (HMO) covers vision services, including one annual routine eye exam for a $30 copay and no coinsurance. Eyewear is partially covered with no copay or coinsurance up to a $200 yearly allowance for contacts, lenses, and frames, though upgrades are not covered.
Dental Services See details
eternalHealth + Fry's Medicare Advantage (HMO) covers dental services, with Medicare-covered dental care requiring a $30 copay and no coinsurance, and other dental services covered up to a $1,000 annual limit. This benefit is partially covered, as adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the eternalHealth + Fry's Medicare Advantage (HMO) plan, requiring prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by eternalHealth + Fry's Medicare Advantage (HMO) with 20% coinsurance and no copay. This benefit ensures you have affordable access to necessary dialysis treatments with clear, predictable out-of-pocket costs.
Medical Equipment See details
Medical equipment benefits are covered under eternalHealth + Fry's Medicare Advantage (HMO) with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are also covered with no copay and a coinsurance ranging from no coinsurance to 20%, with prior authorization required for these services.
Diagnostic and Radiological Services See details
eternalHealth + Fry's Medicare Advantage (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, a $10 copay for outpatient x-rays, and copays ranging from $0 to $60 for diagnostic tests, $60 for therapeutic radiology, and $75 to $160 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the eternalHealth + Fry's Medicare Advantage (HMO) plan. While these essential in-home care benefits are covered, specific copay and coinsurance details are not provided in this summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the eternalHealth + Fry's Medicare Advantage (HMO) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by the eternalHealth + Fry's Medicare Advantage (HMO) plan, as additional days beyond Medicare-covered days are not covered. Covered days require prior authorization and feature no copay and no coinsurance for days 1 through 20, and a $203 daily copay with no coinsurance for days 21 through 100.
Other Services See details
eternalHealth + Fry's Medicare Advantage (HMO) partially covers Other Services, providing a meal benefit for chronic illnesses and a $125 quarterly reimbursement for over-the-counter items with no copays or coinsurance. Acupuncture and dual eligible SNP services are not covered under this plan.
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