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Senior Health Plan Silver Savings (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Health Plan Silver Savings (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 Savings (HMO) in 2025, please refer to our full plan details page.
Senior Health Plan Silver Savings (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 Savings (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 Savings (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 Savings (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 $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:
Sign up for Senior Health Plan Silver Savings (HMO)
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Drug Coverage
Prescription drugs are not covered by Senior Health Plan Silver Savings (HMO).
Additional Benefits
The Senior Health Plan Silver Savings (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and coverage for ambulance services, emergency services, and a variety of doctor visits with copays. Preventive services, hearing, vision, and dental care are also included, with specific limits and copays for each. This plan also covers home health services with no copay, medical equipment with coinsurance, and diagnostic services with copays. However, some services like cardiac rehabilitation, additional home health care, and certain dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $265 for days 1-5 and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay, while Non-Medicare-covered Stay and Upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services, Observation Services, and ASC Services have a $250 copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay between $20 and $20, and Outpatient Blood Services have a deductible waived for the first three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the Senior Health Plan Silver Savings (HMO) with a $50 copay, but requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $250 copay. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year, using a taxi or medical transport. Transportation Services 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 Savings (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $30 copay, and Worldwide Emergency Transportation has a $250 copay; all services have no coinsurance.
Primary Care See details
The Senior Health Plan Silver Savings (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 $30 copay, and mental health specialty services with a $20 copay for individual or group sessions. Additionally, physical therapy and speech-language pathology services are covered with a $20 copay, and telehealth services are covered with a copay between $0 and $30.
Preventive Services See details
The Senior Health Plan Silver Savings (HMO) plan covers preventive services including annual physical exams, glaucoma screenings, and diabetes self-management training, with a doctor referral sometimes required. This plan also covers fitness benefits, remote access technologies, and personal emergency response systems. However, services such as health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
The Senior Health Plan Silver Savings (HMO) plan covers hearing exams, routine hearing exams (1 exam every year), fitting/evaluation for hearing aids (1 exam every two years), prescription hearing aids (all types, up to $500 every two years), and OTC hearing aids (up to $500 every two years). 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 Savings (HMO) plan covers routine eye exams once per year, and eyewear with a combined maximum of $300 per year. Contact lenses and eyeglasses (lenses and frames) are also covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $30 copay. Other dental services include Oral Exams (limited to 2 visits per 12 months), Dental X-Rays (limited to 1 per 12 or 36 months), Prophylaxis (Cleaning) (limited to 2 treatments per 12 months), Fluoride Treatment (limited to 2 treatments per 12 months), and Orthodontic Services (maximum benefit of $1500 per year). Endodontics and Prosthodontics, removable have a 50% coinsurance, while Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Senior Health Plan Silver Savings (HMO) plan, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 by the Senior Health Plan Silver Savings (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-15% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay; however, 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 under the Senior Health Plan Silver Savings (HMO). Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $100, while 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 Savings (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Senior Health Plan Silver Savings (HMO). Specifically, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Senior Health Plan Silver Savings (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $140 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Senior Health Plan Silver Savings (HMO), acupuncture, meal benefits, 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. Over-the-counter items are covered, with a maximum benefit of $50 every three months. Other 1 services cover Non Medicare Covered DME.
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