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Senior Health Plan Platinum (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Health Plan Platinum (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Health Plan Platinum (HMO) in 2026, please refer to our full plan details page.
Senior Health Plan Platinum (HMO) is a HMO plan offered by St Francis Health System & St John Health System available for enrollment in 2025 to people living in Select counties in N.E. and Central Oklahoma. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Senior Health Plan Platinum (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 Senior Health Plan Platinum (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 Senior Health Plan Platinum (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.00. 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 $4200.00 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 Senior Health Plan Platinum (HMO) features a $200 drug deductible before coverage begins. For Tier 1 preferred generic drugs, you will pay no copay for up to a three-month supply at standard pharmacies and through standard mail order. Tier 2 generic drugs also have no copay when filled via standard mail order, while standard pharmacy fills require a copay of $5.00 for a one-month supply, $10.00 for a two-month supply, or $15.00 for a three-month supply. Higher-tier medications require coinsurance rather than flat copays at standard pharmacies and through standard mail order. You will pay a 20% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs are limited to a one-month supply and carry a 30% coinsurance.
Additional Benefits
The Senior Health Plan Platinum (HMO) offers comprehensive coverage for essential medical services with predictable cost-sharing and no coinsurance for many primary benefits. Under this plan, primary care visits feature no copay, while specialist visits require a $30 copay. For hospital care, inpatient stays require a $270 daily copay for the first seven days followed by no copay, while outpatient hospital services carry a $270 copay. This plan also covers routine dental, vision, and hearing care with no copay for standard exams alongside allowances for eyewear and hearing aids. Dental benefits are covered up to a $1,000 annual limit, with most preventive services requiring no copay and no coinsurance. Furthermore, home health services are available with no copay, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Senior Health Plan Platinum (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $270 daily copay for days 1 through 7 and no copay for day 8 and beyond. This benefit is partially covered because non-Medicare-covered stays and upgrades are not covered, and prior authorization and referrals are required.
Outpatient Services See details
Outpatient services under the Senior Health Plan Platinum (HMO) are covered with no coinsurance, featuring a $270 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require a $20 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Senior Health Plan Platinum (HMO) covers partial hospitalization services with a copay of either $30 or $50 and no coinsurance. Prior authorization is required for these services, and certain options may also require a referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Senior Health Plan Platinum (HMO), featuring a $250 copay and no coinsurance for ground and air ambulance services, with the copay waived if you are admitted to the hospital. Non-emergency transportation is partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved health-related locations, though transportation to any other health-related location is not covered.
Emergency Services See details
Senior Health Plan Platinum (HMO) covers emergency services with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays ranging from $30 to $250 depending on the service.
Primary Care See details
Senior Health Plan Platinum (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Most other covered benefits, including physical, occupational, psychiatric, and mental health therapies, require a $20 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Senior Health Plan Platinum (HMO) preventive services are partially covered with no copay and no coinsurance, though referrals are required for zero-dollar preventive services, kidney disease education, and digital rectal exams. While annual physicals, fitness benefits, and remote technologies are covered, several services—including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and home-based palliative care—are not covered.
Hearing Services See details
Hearing services are partially covered by the Senior Health Plan Platinum (HMO) with no copay and no coinsurance for routine exams, fittings, and hearing aids. While OTC and prescription hearing aids are covered up to a $500 maximum every two years, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are partially covered by Senior Health Plan Platinum (HMO) with no copay and no coinsurance, offering one routine eye exam per year and a $400 annual maximum for contact lenses and eyeglasses. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Senior Health Plan Platinum (HMO) partially covers dental services up to a $1,000 annual limit, with Medicare-covered dental requiring a $30 copay and no coinsurance. Most covered preventive and comprehensive services have no copay and no coinsurance, although endodontics and removable prosthodontics require a 50% coinsurance and no copay, and implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Senior Health Plan Platinum (HMO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Senior Health Plan Platinum (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
Senior Health Plan Platinum (HMO) covers durable medical equipment with no copay, 0% to 15% coinsurance, and prior authorization, while prosthetics and medical supplies require prior authorization with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Senior Health Plan Platinum (HMO) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization and referrals for all services. Covered diagnostic procedures and tests carry a copay ranging from no copay to $100, and diagnostic radiological services have no copay, while lab services, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Senior Health Plan Platinum (HMO) with no copay and no coinsurance, though prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Senior Health Plan Platinum (HMO) with no copay and no coinsurance, though prior authorization and a referral are required. While unlimited standard cardiac rehabilitation is covered, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Senior Health Plan Platinum (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $140 daily copay for days 21 through 100. Prior authorization and referrals are required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Senior Health Plan Platinum (HMO) partially covers Other Services with no copay and no coinsurance for over-the-counter (OTC) items, up to a $40 limit every three months, and non-Medicare covered durable medical equipment. Acupuncture and meal benefits are not covered under this plan.
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