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Senior Health Plan Silver Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Health Plan Silver 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 Silver Plus (HMO) in 2025, please refer to our full plan details page.
Senior Health Plan Silver 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 Silver 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 Silver 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 Silver Plus (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.
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 $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 Silver Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, you will pay a $5 copay at a standard pharmacy for tier 1 drugs, and a 40% coinsurance for tier 3 drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0 for all covered drugs.
Additional Benefits
The Senior Health Plan Silver Plus (HMO) offers a range of benefits, including inpatient hospital stays with a copay for the first few days, and outpatient services with varying copays depending on the service. The plan also covers emergency services, primary care, and preventive services, with specific copays or no copays for many services. Additional benefits include coverage for hearing, vision, and dental services, with limitations on specific services like hearing aids and eyewear. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services, with specific copays or coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. For days 1-5, you will have a $240 copay, and for days 6-90, there is no copay; additional days are covered with no copay.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $235 copay, while individual and group substance abuse sessions have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Senior Health Plan Silver Plus (HMO) with a $55 copay. Prior authorization and a doctor referral are required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $250 copay, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year via taxi or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Senior Health Plan Silver Plus (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $250 copay, while Worldwide Urgent Coverage has a $30 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services have a $20 copay, Physician Specialist Services have a $30 copay, Occupational Therapy Services have a $15 copay, Individual and Group Sessions for Mental Health and Psychiatric Services have a $20 copay, Physical Therapy and Speech-Language Pathology Services have a $15 copay, Additional Telehealth Benefits have a $0-$30 copay, and Opioid Treatment Program Services have a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and additional preventive services. 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 Benefit, 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 are not covered.
Hearing Services See details
Hearing exams and OTC hearing aids are covered by the Senior Health Plan Silver Plus (HMO), with routine hearing exams limited to one per year, and prescription hearing aids (all types) are covered. Fitting/Evaluation for Hearing Aid, 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 Plus (HMO) plan covers vision services including routine eye exams once per year and eyewear with a combined maximum benefit of $400 every year; contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay and require prior authorization, as well as other dental services. Oral exams are limited to 2 visits every 12 months, and dental x-rays, prophylaxis (cleaning), and fluoride treatments are limited to 1 or 2 treatments per 12 months. Orthodontic services have a maximum plan benefit of $1500 every year. Endodontics and prosthodontics, removable have a 50% coinsurance, and other services have visit limits. Maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Senior Health Plan Silver Plus (HMO), but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment (DME) with a 0-15% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, diabetic supplies, and therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but lab services, therapeutic radiological services, and outpatient x-ray services are not covered. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $150, while Diagnostic Radiological Services have a copay of at most $100.
Home Health Services See details
Home Health Services are covered by the Senior Health Plan Silver Plus (HMO) with no copay and no coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Senior Health Plan Silver Plus (HMO). Prior authorization is required for this benefit, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Senior Health Plan Silver Plus (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $140. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $85 every three months, and Other 1, which covers Non Medicare Covered DME. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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.
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