A non-government entity
Samaritan Advantage Premier Plan Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Samaritan Advantage Premier Plan Plus (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 Plus (HMO) in 2025, please refer to our full plan details page.
Samaritan Advantage Premier Plan Plus (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 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 Samaritan Advantage Premier Plan 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 Samaritan Advantage Premier Plan Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $138.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3750.00 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 Samaritan Advantage Premier Plan Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Samaritan Advantage Premier Plan Plus (HMO) has an "Enhanced Alternative" drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $12 copay at a preferred pharmacy, while preferred brand drugs have a 50% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Samaritan Advantage Premier Plan Plus (HMO) offers a wide range of benefits, including inpatient hospital stays with a copay, outpatient services, and coverage for ambulance and emergency services. This plan also includes coverage for primary care visits, preventive services with no copay, and vision and dental services, each with specific copays and maximum benefits. Additionally, the plan offers coverage for hearing services, home health services with no copay, and access to medical equipment. This plan provides coverage for a variety of additional services such as acupuncture, and over-the-counter items. However, it's important to note that the plan does not cover certain services like cardiac rehabilitation, and some home and community-based services. Also, some services require prior authorization, so it is important to review the details of the coverage.
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, and a $1000 copay for Inpatient Hospital Psychiatric. Additional days and non-Medicare covered stays for both are not covered.
Outpatient Services See details
Outpatient services are covered under the Samaritan Advantage Premier Plan Plus (HMO), including outpatient hospital services with a copay of $35-$300, observation services with a copay of $90, ambulatory surgical center services with a copay of $250, and outpatient substance abuse services with 20% coinsurance for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Samaritan Advantage Premier Plan Plus (HMO) and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $250 copay, while air ambulance services have 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 Plus (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have a $35 copay, and there is 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 Plus (HMO) covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $15 copay, Other Health Care Professional with a copay between $0 and $10, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with 20% coinsurance. This plan does not cover Mental Health Specialty Services, Podiatry Services, or Psychiatric Services for individual and group sessions.
Preventive Services See details
The Samaritan Advantage Premier Plan Plus (HMO) covers preventive services, including annual physical exams, with no copay. Additional preventive services are partially covered, with Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services not covered. This plan also covers Personal Emergency Response System (PERS), Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $25 copay, and for prescription hearing aids with a maximum benefit of $2750 every year; however, the plan does not cover fitting/evaluation for hearing aids, or prescription hearing aids of the inner ear, outer ear, or over the ear. OTC hearing aids are also covered, with a maximum benefit of $2750 every year.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay and routine eye exams with a $5 copay, as well as coverage for eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit coverage amount of $2750 per year.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $20 copay. Other Dental Services include 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, oral and maxillofacial surgery, and orthodontics. There is a $2,750 maximum plan benefit each year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Samaritan Advantage Premier Plan Plus (HMO), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a coinsurance of 20% and no copay. 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 by the Samaritan Advantage Premier Plan Plus (HMO). Diagnostic services, and lab services are not covered, but outpatient x-ray services have a $10 copay and a 20% coinsurance, while diagnostic and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Samaritan Advantage Premier Plan Plus (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 Plus (HMO). Specifically, Cardiac Rehabilitation 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) services are covered by the Samaritan Advantage Premier Plan Plus (HMO), but require prior authorization. There is no copay for days 1-20 and days 46-100, but there is a $165 copay for days 21-45. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Samaritan Advantage Premier Plan Plus (HMO) covers acupuncture with a $10 copay per visit, up to 30 treatments per year, and also covers over-the-counter items up to $125 every three months. Some other services are not covered, including 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved