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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 2026, 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 3.5 out of 5 stars in 2026.
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) offers affordable healthcare coverage with many essential services featuring no copays or coinsurance. Members benefit from no copayments for primary care visits, preventive care, routine eye exams, and home health services. For other medical needs, the plan requires predictable copays, such as $35 for specialist visits, $20 for physical therapy, and a $265 daily copay for the first five days of inpatient hospital stays. This Medicare Advantage plan also includes valuable supplemental benefits, such as up to 12 one-way transportation trips per year and a $300 annual allowance for contacts and eyeglasses. Dental services are covered up to a $1,000 annual limit with no copay for preventive care, while emergency room care incurs a $90 copay that is waived if admitted. Most medical equipment and Part B drugs are covered with no copays, though some items may require coinsurance ranging up to 20 percent.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Senior Health Plan Silver Savings (HMO) with no coinsurance, requiring prior authorization and a referral. Covered acute and psychiatric stays incur a $265 daily copay for days 1 through 5 and no copay for days 6 and beyond, while upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Health Plan Silver Savings (HMO) covers outpatient services with no coinsurance, featuring a $250 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require a $20 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Senior Health Plan Silver Savings (HMO) covers partial hospitalization services with a copay of $35 or $50 and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
Senior Health Plan Silver Savings (HMO) covers ambulance services with a $250 copay and no coinsurance, which is waived if you are admitted to the hospital. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Senior Health Plan Silver Savings (HMO) covers emergency services with a $90 copay (waived if admitted within 48 hours) and urgently needed services with a $35 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $90, $35, and $250 respectively.
Primary Care See details
Senior Health Plan Silver Savings (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical therapy, occupational therapy, mental health, and psychiatric services require a $20 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Senior Health Plan Silver Savings (HMO) with no copay and no coinsurance, though some services like kidney disease education and digital rectal exams require a referral. Additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Senior Health Plan Silver Savings (HMO) with no copay, no coinsurance, and no deductible for exams, fittings, and hearing aids. However, prescription hearing aids are only partially covered, as inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Vision services are partially covered by the Senior Health Plan Silver Savings (HMO) with no copay, no coinsurance, and no deductibles. The plan covers one routine eye exam per year and up to $300 annually for contact lenses and eyeglasses (lenses and frames), but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Senior Health Plan Silver Savings (HMO) partially covers dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay with either no coinsurance or 50% coinsurance for other preventive and comprehensive benefits up to a $1,000 annual limit. Services not covered include other diagnostic, other preventive, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Senior Health Plan Silver Savings (HMO) with no copay, subject to prior authorization. Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Senior Health Plan Silver Savings (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Senior Health Plan Silver Savings (HMO) covers medical equipment with no copays, including durable medical equipment at 0% to 15% coinsurance and prosthetics and medical supplies at 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 Silver Savings (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Covered diagnostic procedures and tests carry a copay of $0 to $100 and diagnostic radiological services have a $0 minimum 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 under the Senior Health Plan Silver Savings (HMO) with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by Senior Health Plan Silver Savings (HMO) with no copay and no coinsurance, although prior authorization is required. 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
Senior Health Plan Silver Savings (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral but allowing admission without a prior three-day hospital stay. Members pay no copay for days 1 through 20 and a $140 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Senior Health Plan Silver Savings (HMO) partially covers other services, offering non-Medicare covered DME and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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