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Senior Health Plan Silver (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Health Plan Silver (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 Silver (HMO) in 2025, please refer to our full plan details page.
Senior Health Plan Silver (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. Oklahoma. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Senior Health Plan Silver (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Health Plan Silver (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 Silver (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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
Prescription drugs are not covered by Senior Health Plan Silver (HMO).
Additional Benefits
The Senior Health Plan Silver (HMO) offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, which is waived after the first week. Outpatient services and emergency services have copays, while ambulance services have a copay that is waived if admitted to the hospital. This plan includes coverage for primary care, hearing, vision, and dental services, each with specific copays, coinsurance, or annual maximums. Additional benefits include coverage for home health services, medical equipment, and diagnostic services, some with coinsurance or copays, as well as coverage for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor referral. For days 1-7, there is a $25 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services, including hospital services and observation services, have a $25 copay. Ambulatory Surgical Center (ASC) Services have a $25 copay. Outpatient Substance Abuse Services have a $5 copay for both individual and group sessions. Outpatient Blood Services are also covered under this plan.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Health Plan Silver (HMO) plan, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance. Ground and air ambulance services have a $25 copay, which is waived if you are admitted to the hospital; additionally, this plan covers 12 one-way trips per year to a plan-approved health-related location via taxi or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Senior Health Plan Silver (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $5 copay, and Worldwide Emergency Transportation has a $25 copay; all services have no coinsurance.
Primary Care See details
The Senior Health Plan Silver (HMO) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy and physical therapy/speech-language pathology services with no copay, physician specialist services with a $5 copay, mental health specialty services with a $5 copay, other health care professional services with a $0-$5 copay, psychiatric services with a $5 copay, additional telehealth benefits with a $0-$5 copay, and opioid treatment program services with a $5 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Senior Health Plan Silver (HMO) plan covers preventive services, including annual physical exams, kidney disease education, and other services like glaucoma screenings and diabetes self-management training. Personal Emergency Response System (PERS), Fitness Benefit, and Remote Access Technologies are also covered. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, and other services are not covered.
Hearing Services See details
Hearing Services are covered under the Senior Health Plan Silver (HMO), including Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids (all types), and OTC Hearing Aids. Routine Hearing Exams, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Senior Health Plan Silver (HMO) plan covers vision services, including routine eye exams, with one exam covered every year, and eyewear, with a combined maximum benefit of $200 every year. Contact lenses and eyeglasses (lenses and frames) are also covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Senior Health Plan Silver (HMO) plan covers Medicare Dental Services with a $5 copay, and other dental services including Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery. Orthodontic services have a maximum benefit of $1500 per year, while Endodontics and Prosthodontics, removable have 50% coinsurance. Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Senior Health Plan Silver (HMO) plan. 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, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Senior Health Plan Silver (HMO), including Durable Medical Equipment (DME) with a coinsurance between 0% and 15%, and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered devices and supplies. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $125, and Diagnostic Radiological Services with a copay up to $125; however, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. Prior authorization and a doctor referral are required for all services.
Home Health Services See details
Home Health Services are covered by the Senior Health Plan Silver (HMO) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Senior Health Plan Silver (HMO), but the plan does not cover Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for the covered services; see the plan details for more information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Health Plan Silver (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $25 per day. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Senior Health Plan Silver (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $40 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone, but acupuncture, meal benefits, Dual Eligible SNPs, 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. Other 1 benefits, including Non Medicare Covered DME, are covered.
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