A non-government entity
Experience Health Medicare Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Experience Health Medicare Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Experience Health Medicare Advantage (HMO) in 2026, please refer to our full plan details page.
Experience Health Medicare Advantage (HMO) is a HMO plan offered by CuraCor Solutions Corp. available for enrollment in 2026 to people living in Triangle and surrounding area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Experience Health Medicare Advantage (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 Experience Health Medicare Advantage (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 Experience Health Medicare Advantage (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.90. 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 $6500.00 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 Experience Health Medicare Advantage (HMO) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 6 (Select Care Drugs) prescriptions filled through standard pharmacies or standard mail order. For Tier 2 (Generic) drugs, standard pharmacy and mail order costs require a $4 copay for a 1-month supply, $8 for a 2-month supply, and $12 for a 3-month supply. Higher-tier prescriptions on this plan are subject to coinsurance rather than flat copays. Tier 3 (Preferred Brand) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance, while Tier 4 (Non-Preferred Drugs) require a 27% coinsurance. These standard cost-sharing rates apply to both standard retail pharmacies and standard mail-order services.
Additional Benefits
The Experience Health Medicare Advantage (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copays and no coinsurance for primary care, preventive care, and home health services. Specialist visits and outpatient mental health services require a $40 copay, while outpatient hospital services carry a copay ranging from no copay to $200. For inpatient hospital stays, members pay a $400 daily copay for the first several days and no copay for additional days, with no coinsurance. In addition to medical care, the plan provides routine dental, vision, and hearing benefits with no copays, including a $0 deductible for vision services. Prescription hearing aids are partially covered with copays between $499 and $999, while Medicare-covered dental services require a $40 copay. Durable medical equipment and dialysis services are covered with no copays and a 20% coinsurance.
Inpatient Hospital See details
Experience Health Medicare Advantage (HMO) partially covers inpatient hospital services with no coinsurance, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For covered services, acute care requires a $400 daily copay for days 1 to 6 and no copay thereafter, while psychiatric care requires a $400 daily copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Experience Health Medicare Advantage (HMO) covers outpatient hospital services with a $0 to $200 copay and no coinsurance, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse services require a $40 copay and no coinsurance, while outpatient blood services have no copay and a 20% coinsurance.
Partial Hospitalization See details
Experience Health Medicare Advantage (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Experience Health Medicare Advantage (HMO) covers Medicare-approved ground and air ambulance services with a $295 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Experience Health Medicare Advantage (HMO) plan are covered with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, while urgently needed services have a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $50 to $295, up to a maximum benefit of $100,000.
Primary Care See details
Experience Health Medicare Advantage (HMO) offers primary care and opioid treatment with no copay and no coinsurance, while specialists, mental health, and psychiatric services require a $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $20 copay and no coinsurance, but podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not covered. Telehealth options are also available with no copay to a $40 copay and no coinsurance.
Preventive Services See details
Experience Health Medicare Advantage (HMO) preventive services are partially covered with no copay and no coinsurance for covered care, including annual physicals, kidney disease education, glaucoma screenings, and fitness benefits. However, several sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Experience Health Medicare Advantage (HMO) covers Medicare-covered hearing exams for a $20 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with copays between $499 and $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Experience Health Medicare Advantage (HMO) covers vision services with no deductible, offering routine eye exams and eyeglasses with no copay, while contact lenses require a 20% coinsurance and other exams have a copay of up to $40. Eye exams feature no coinsurance, and a combined maximum benefit of $300 per year applies to these vision services.
Dental Services See details
Experience Health Medicare Advantage (HMO) covers Medicare-covered dental services with a $40 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. Preventive services are subject to a $250 annual maximum, and comprehensive services, including orthodontics and restorative care, have a $750 annual maximum.
Home Infusion bundled Services See details
Experience Health Medicare Advantage (HMO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Experience Health Medicare Advantage (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Experience Health Medicare Advantage (HMO) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, and diabetic shoes carry a 20% coinsurance, while covered diabetic supplies from specified manufacturers range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Experience Health Medicare Advantage (HMO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services carry no coinsurance, offering no copay for lab tests and a $0 to $20 copay for other diagnostic procedures. Radiological services feature no copay for X-rays and diagnostic radiology, while therapeutic radiological services require a minimum 20% coinsurance and copays starting at $0.
Home Health Services See details
Home health services are covered by the Experience Health Medicare Advantage (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Experience Health Medicare Advantage (HMO) plan with no coinsurance, although copayments apply to covered services. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Experience Health Medicare Advantage (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Experience Health Medicare Advantage (HMO) partially covers other services, offering select over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. A referral is required for the meal benefit, and the over-the-counter benefit is limited to nicotine replacement therapy.
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