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Senior Health Plan Platinum Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Health Plan Platinum Plus (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 Plus (HMO) in 2026, please refer to our full plan details page.
Senior Health Plan Platinum Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $97.00. 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 $5000.00 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 Plus (HMO) features a $200 drug deductible and offers savings on generic medications. Tier 1 preferred generic drugs have no copay for standard pharmacy and mail-order prescriptions up to a three-month supply. Tier 2 generic drugs cost between $5 and $15 at standard pharmacies, but feature no copay when ordered through standard mail services. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs have a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs are covered with a 30% coinsurance for a one-month supply.
Additional Benefits
The Senior Health Plan Platinum Plus (HMO) offers robust healthcare coverage with no copay or coinsurance for primary care visits, while specialist visits require a $25 copay. Inpatient hospital stays feature a $225 daily copay for the first seven days and no copay thereafter, while outpatient hospital services also carry a $225 copay. Emergency care is accessible with a $120 copay, and urgent care visits require a low $25 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to $1,000 annually and a $200 annual vision allowance for contacts or eyeglasses with no copays. Routine hearing exams and over-the-counter items up to $40 every three months are fully covered with no copay, as are home health services. Additionally, there is no copay or coinsurance for preventive services, helping you manage your health and wellness affordably.
Inpatient Hospital See details
Senior Health Plan Platinum Plus (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 daily copay for days 1 to 7 and no copay for days 8 and beyond. Prior authorization and referrals are required, and the plan does not cover upgrades or non-Medicare-covered stays.
Outpatient Services See details
Senior Health Plan Platinum Plus (HMO) covers outpatient services with no coinsurance, featuring a $225 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require a $20 copay per session, and outpatient blood services are fully covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Senior Health Plan Platinum Plus (HMO) with a copay ranging from $25 to $50 and no coinsurance. Prior authorization and referrals are required for these services.
Ambulance and Transportation Services See details
Senior Health Plan Platinum Plus (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Transportation services are partially covered, providing up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Senior Health Plan Platinum Plus (HMO) covers emergency services with a $120 copay, which is waived if admitted within 48 hours, and urgently needed services with a $25 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $120, $25, and $250 respectively.
Primary Care See details
Senior Health Plan Platinum Plus (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Therapy, mental health, and psychiatric services generally require a $20 copay and no coinsurance, but podiatry is not covered, and chiropractic services are only partially covered with routine care excluded.
Preventive Services See details
Preventive services are partially covered by Senior Health Plan Platinum Plus (HMO) with no copay and no coinsurance, although some services require a referral. Covered benefits include annual physical exams, fitness benefits, and remote access technologies, while services such as health education, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by Senior Health Plan Platinum Plus (HMO) with no copay and no coinsurance for exams, fittings, and hearing aids. While routine exams, fittings, and OTC hearing aids are covered, prescription hearing aids are limited to a $500 allowance every two years, and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered by the Senior Health Plan Platinum Plus (HMO) with no copay and no coinsurance, offering one routine eye exam per year and a $200 annual allowance for contact lenses or eyeglasses. This benefit is partially covered, as other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Senior Health Plan Platinum Plus (HMO) offers partially covered dental services up to a $1,000 annual limit, with Medicare-covered dental requiring a $25 copay and no coinsurance. Most covered preventive and comprehensive services feature no copay and no coinsurance, while endodontics and removable prosthodontics require no copay and a 50% coinsurance; however, implants, orthodontics, fixed prosthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Senior Health Plan Platinum Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Senior Health Plan Platinum Plus (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
Senior Health Plan Platinum Plus (HMO) partially covers medical equipment, offering durable medical equipment with no copay and up to 15% coinsurance, and prosthetics with no copay and 20% coinsurance. Diabetic equipment is 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 Plus (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Covered diagnostic procedures and tests have a copay ranging from $0 to $155, 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 Platinum Plus (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Senior Health Plan Platinum Plus (HMO) with no copay and no coinsurance, though prior authorization is required. While unlimited standard cardiac rehabilitation is covered, 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
Skilled Nursing Facility (SNF) services are partially covered by Senior Health Plan Platinum Plus (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $160 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Senior Health Plan Platinum Plus (HMO) partially covers other services with no copay and no coinsurance for over-the-counter (OTC) items up to $40 every three months and non-Medicare covered durable medical equipment. Acupuncture, meal benefits, and other select services are not covered under this plan.
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