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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 2026, 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 3.5 out of 5 stars in 2026.
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 a $615.00 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 $5400.00 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) has an annual prescription drug deductible of $615. There is no copay for Tier 1 preferred generic drugs at standard pharmacies or through standard mail order. For Tier 2 generic drugs, you will pay no copay for standard mail order, or a standard pharmacy copay of $5 for a 1-month, $10 for a 2-month, and $15 for a 3-month supply. Higher-tier medications require coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs have a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance at standard pharmacies and standard mail order. This straightforward structure makes it easy to estimate your out-of-pocket prescription costs with the Senior Health Plan Silver Plus (HMO).
Additional Benefits
The Senior Health Plan Silver Plus (HMO) provides comprehensive medical coverage with no copay for primary care visits, while specialist visits require a $35 copay. Inpatient hospital stays feature no coinsurance and a $300 daily copay for the first seven days, after which there is no copay. Emergency care is available with a $120 copay, and outpatient hospital services have a $300 copay, both with no coinsurance. This plan also features robust supplemental benefits, including no copays for routine hearing and vision exams, alongside a $400 annual allowance for eyewear and a $1,000 yearly dental maximum. Additionally, members can access up to 12 one-way transportation trips per year and home health services with no copay or coinsurance. Durable medical equipment is covered with no copays and coinsurance ranging from 0% to 15%.
Inpatient Hospital See details
Senior Health Plan Silver Plus (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 7 and no copay for days 8 and beyond. The benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Senior Health Plan Silver Plus (HMO) require no coinsurance, featuring a $300 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require a $20 copay per session, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Senior Health Plan Silver Plus (HMO) covers partial hospitalization services with no coinsurance, requiring a copayment of either $35 or $50 depending on referral requirements. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Senior Health Plan Silver Plus (HMO) covers ambulance services with a $250 copay and no coinsurance per ground or air trip, which is waived if you are admitted. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by Senior Health Plan Silver Plus (HMO) with a $120 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $35 to $250.
Primary Care See details
Senior Health Plan Silver Plus (HMO) covers primary care doctor visits with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Therapy services carry a $25 copay and no coinsurance, mental health services require a $20 copay and no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Senior Health Plan Silver Plus (HMO) partially covers preventive services with no copay and no coinsurance, which includes annual physical exams, fitness benefits, remote access technologies, and kidney disease education. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered under the Senior Health Plan Silver Plus (HMO) with no copay and no coinsurance for routine exams, prescription hearing aids, and OTC hearing aids. Fitting and evaluation services, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by the Senior Health Plan Silver Plus (HMO) with no copay, no coinsurance, and no deductible. The plan covers one routine eye exam per year and up to $400 annually for contact lenses and eyeglasses (lenses and frames), but other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Senior Health Plan Silver Plus (HMO) features partially covered dental services up to a $1,000 yearly maximum, where Medicare-covered dental has a $35 copay and no coinsurance, and most covered preventive and comprehensive services have no copay and no coinsurance (except endodontics and removable prosthodontics, which have no copay and a 50% coinsurance). Other diagnostic, other preventive, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Senior Health Plan Silver Plus (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Senior Health Plan Silver Plus (HMO) 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 Silver Plus (HMO) partially covers medical equipment with no copays, offering durable medical equipment at 0% to 15% coinsurance and prosthetics and medical supplies at 20% coinsurance. Diabetic equipment is covered with no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Senior Health Plan Silver Plus (HMO) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization and referrals for all services. Covered diagnostic procedures and tests have a copay ranging from no copay up to $150, and diagnostic radiological services have no copay, while lab services, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Senior Health Plan Silver Plus (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Senior Health Plan Silver Plus (HMO) partially covers Cardiac Rehabilitation Services with a $15 copay, no coinsurance, and prior authorization requirements. While basic cardiac rehabilitation is covered, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Senior Health Plan Silver Plus (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $140 daily copay for days 21 to 100. Prior authorization and referrals are required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Senior Health Plan Silver Plus (HMO) partially covers Other Services, offering over-the-counter (OTC) items up to $30 every three months and non-Medicare covered durable medical equipment (DME) with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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