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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 2025, 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 4 out of 5 stars in 2025.
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 $83.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4700.00 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) has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you may have no copay for preferred generic drugs through standard mail, or a $5 copay at a standard pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Senior Health Plan Platinum Plus (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. Emergency, primary care, and preventive services are covered, with copays for many services. The plan also covers hearing, vision, and dental services, along with home infusion, dialysis, and medical equipment. Other benefits include ambulance services, transportation, and skilled nursing, with specific copays or coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $220 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, and ASC services have a $200 copay, while individual and group outpatient substance abuse sessions have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Senior Health Plan Platinum Plus (HMO) plan, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $250 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $25 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Senior Health Plan Platinum Plus (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $25 copay, mental health specialty services with a $20 copay, physical therapy, and speech-language pathology services with a $20 copay. The plan also covers additional telehealth benefits with a copay between $0 and $25 and opioid treatment program services with a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Some additional preventive services are not covered, including health education, in-home safety assessment, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services. Personal Emergency Response System (PERS), Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
The Senior Health Plan Platinum Plus (HMO) plan covers hearing exams, routine hearing exams (1 visit every year), and fitting/evaluation for hearing aids (1 visit every two years). Prescription hearing aids are covered with a plan maximum of $500 every two years, and OTC hearing aids are covered with a plan maximum of $500 every two years. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Senior Health Plan Platinum Plus (HMO) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $200 per year. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Senior Health Plan Platinum Plus (HMO) covers dental services, including oral exams with a $25 copay, and Medicare Dental Services with a $25 copay, but some services like maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. Endodontics and prosthodontics (removable) have a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Senior Health Plan Platinum Plus (HMO) with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and 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 with prior authorization and a doctor's referral. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment with 0-15% coinsurance and no copay, prosthetics with 20% coinsurance and no copay, and medical supplies with 20% coinsurance and no copay. 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 by the Senior Health Plan Platinum Plus (HMO), but Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. For Diagnostic Procedures/Tests, you may have a copay between $0.00 and $155.00, and for Diagnostic Radiological Services, you may have a copay of up to $155.00.
Home Health Services See details
Home Health Services are covered under the Senior Health Plan Platinum Plus (HMO) with no copay and no coinsurance, but require both authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and a copay applies, but more details are needed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Senior Health Plan Platinum Plus (HMO), but require prior authorization and a doctor referral. There is no copay for days 1-20, and a $160 copay for days 21-100.
Other Services See details
The Senior Health Plan Platinum Plus (HMO) plan covers over-the-counter (OTC) items, with a maximum benefit coverage amount of $40.00 every three months; it also offers nicotine replacement therapy and Naloxone coverage as a Part C OTC benefit. Acupuncture, meal benefits, and various other services are not covered.
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