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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 2026, 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 3.5 out of 5 stars in 2026.
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 affordable medical coverage with low out-of-pocket costs, featuring no copays and no coinsurance for primary care, physical therapy, and home health services. For hospital stays and emergency care, members pay predictable fixed costs, including a $25 daily copay for inpatient days one through seven and a $90 copay for emergency room visits. Outpatient hospital services and ambulance rides also carry a low $25 copay, helping to keep essential care highly accessible. This plan also includes valuable supplemental benefits, such as routine vision exams and dental care with no copays, alongside allowances for eyewear and hearing aids. Members benefit from no copays on durable medical equipment, diabetic equipment, and select over-the-counter items up to $30 every three months. Specialist visits and mental health services are also highly affordable, requiring only a $5 copay and no coinsurance.
Inpatient Hospital See details
Senior Health Plan Silver (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $25 daily copay for days 1 through 7 and no copay for days 8 and beyond. Prior authorization and referrals are required for these services, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Health Plan Silver (HMO) covers outpatient services with no coinsurance, featuring a $25 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse sessions require a $5 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Senior Health Plan Silver (HMO) with either no copay or a $5 copay, and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Senior Health Plan Silver (HMO) covers ground and air ambulance services with a $25 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Senior Health Plan Silver (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services have a $5 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $90, $5, and $25 respectively.
Primary Care See details
Senior Health Plan Silver (HMO) features no copay and no coinsurance for primary care, occupational therapy, and physical therapy. Specialist, mental health, psychiatric, and opioid treatment services require a $5 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Senior Health Plan Silver (HMO) preventive services are partially covered with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and fitness benefits. Several supplemental preventive services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, nutritional benefits, and weight management programs.
Hearing Services See details
Senior Health Plan Silver (HMO) partially covers hearing services with no copay and no coinsurance, although routine hearing exams and inner ear, outer ear, and over the ear prescription hearing aids are not covered. Covered benefits include one fitting evaluation every two years, up to $500 every two years for prescription hearing aids, and up to $500 every two years for OTC hearing aids.
Vision Services See details
Senior Health Plan Silver (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible, featuring one routine eye exam per year and a $200 annual limit for eyeglasses and contact lenses. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Senior Health Plan Silver (HMO), offering Medicare-covered dental with a $5 copay and no coinsurance, and other covered services with no copay and either no coinsurance or 50% coinsurance up to a $1,000 annual limit. Sub-services that are not covered include other diagnostic, other preventive, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Senior Health Plan Silver (HMO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Senior Health Plan Silver (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 Silver (HMO) covers durable medical equipment with no copay and 0% to 15% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance, both requiring prior authorization. Diabetic equipment is covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Senior Health Plan Silver (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Covered diagnostic procedures and tests carry a copay of up to $125, and diagnostic radiological services have no copay, but 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 Silver (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Senior Health Plan Silver (HMO) with no copay and no coinsurance, although prior authorization is required. While standard cardiac rehabilitation is unlimited, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Senior Health Plan Silver (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $25 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-covered limit are not covered.
Other Services See details
Senior Health Plan Silver (HMO) partially covers Other Services, providing no copay and no coinsurance for non-Medicare covered durable medical equipment (DME) and over-the-counter (OTC) items up to $30 every three months. Acupuncture and meal benefits are not covered under this benefit.
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