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Samaritan Advantage Premier Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Samaritan Advantage Premier Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Samaritan Advantage Premier Plan (HMO) in 2025, please refer to our full plan details page.
Samaritan Advantage Premier Plan (HMO) is a HMO plan offered by Samaritan Health Services available for enrollment in 2025 to people living in Benton, Lincoln and Linn counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Samaritan Advantage Premier Plan (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 Samaritan Advantage Premier Plan (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 Samaritan Advantage Premier Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $175.00 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 $4250.00 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 Samaritan Advantage Premier Plan (HMO) has a $175 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $12 copay at a preferred pharmacy or a $20 copay at a standard pharmacy. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Samaritan Advantage Premier Plan (HMO) offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, like hospital and ambulatory surgical centers, have copays as well. Emergency services and urgent care have copays, and ambulance services have a copay or coinsurance depending on the type of service. This plan includes coverage for primary care, preventive, hearing, vision, and dental services. Primary care and many preventive services have no copay, while hearing aids are covered up to $2,000 per year. Dental services have a $20 copay, with a maximum benefit of $2,000 per year. Additional benefits include home health services with no copay, skilled nursing facility with no copay for some days, and coverage for acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $325 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, while Inpatient Hospital Psychiatric has a $1500 copay for Medicare-covered stays. Additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay of $35.00 - $550.00, observation services with a $110 copay, and ambulatory surgical center (ASC) services with a $325 copay. Outpatient substance abuse services have a 20% coinsurance for individual and group sessions, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered, but require prior authorization. There is no information about the cost of the services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Samaritan Advantage Premier Plan (HMO). Ground Ambulance Services have a $300 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Samaritan Advantage Premier Plan (HMO). Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $35 copay, with no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Samaritan Advantage Premier Plan (HMO) covers primary care physician services with a copay between $0 and $15, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a copay between $25 and $45. Mental health specialty services, psychiatric services, and other health care professional visits have varying copays, and physical therapy and speech-language pathology services have a $30 copay. Opioid treatment program services have 20% coinsurance.
Preventive Services See details
The Samaritan Advantage Premier Plan (HMO) covers preventive services, including an annual physical exam and additional preventive services like glaucoma screening and diabetes self-management training, with no copay for many services, but a copay between $10 and $25 for the Fitness Benefit. Other covered services include kidney disease education services, personal emergency response systems, and barium enemas. However, services like health education and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids, with routine hearing exams costing a $10 copay and prescription hearing aids covered up to $2,000 per year. Fitting/evaluation for hearing aids, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $30 copay, and routine eye exams with a $10 copay for one visit per year. Eyewear is covered with a combined maximum benefit of $2000 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Samaritan Advantage Premier Plan (HMO) covers Medicare Dental Services with a $20 copay, and covers other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery. Orthodontics is not covered. This plan has a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Samaritan Advantage Premier Plan (HMO), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, and Medical Supplies, is covered under the Samaritan Advantage Premier Plan (HMO). Durable Medical Equipment has a 20% coinsurance and requires prior authorization, while equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Equipment is covered, but Diabetic Supplies and Therapeutic Shoes/Inserts are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services are not covered. Outpatient X-Ray Services have a $15 copay, and Diagnostic and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Samaritan Advantage Premier Plan (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Samaritan Advantage Premier Plan (HMO). The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Samaritan Advantage Premier Plan (HMO), but require prior authorization. For days 1-20 and 46-100, there is no copay, and for days 21-45, the copay is $203.
Other Services See details
The Samaritan Advantage Premier Plan (HMO) covers acupuncture with a $20 copay per visit, up to 30 treatments per year. Over-the-counter (OTC) items are also covered, with a maximum benefit of $100 every three months. Several other services, including meal benefits, are not covered.
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