A non-government entity
Senior Care (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Senior Care (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Senior Care (HMO I-SNP) in 2026, please refer to our full plan details page.
Senior Care (HMO I-SNP) is a HMO I-SNP plan offered by Missouri Healthcare Advisors, LLC available for enrollment in 2025 to people living in MO-partial TN-partial SC-partial NC-partial. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Senior Care (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Senior Care (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Senior Care (HMO I-SNP).
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 Care (HMO I-SNP), 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.
This plan has a $250.00 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 $5000.00 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 Care (HMO I-SNP)
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 Senior Care (HMO I-SNP) Medicare plan features an annual drug deductible of $250 before coverage begins. For standard pharmacies, Tier 1 preferred generic drugs cost a $2 copay for a 1-month supply, while Tier 2 generic drugs require a $15 copay. Multi-month supplies are also available, with a 3-month supply costing $6 for preferred generics and $45 for generics. Higher tier medications under this plan incur larger out-of-pocket costs at standard pharmacies. Tier 3 preferred brand drugs carry a $45 copay for a 1-month supply, and Tier 4 non-preferred drugs cost $95. For specialty medications in Tier 5, members are responsible for a 30% coinsurance for a 1-month supply.
Additional Benefits
The Senior Care (HMO I-SNP) plan offers robust medical coverage with no copay for primary care visits, home health services, and skilled nursing facility admissions. Specialist visits require a low $25 copay, while inpatient hospital stays charge a $295 daily copay for the first six days before transitioning to no copay. Emergency room visits carry a $90 copay, which is waived if you are admitted to the hospital within three days. This plan also features valuable dental, vision, and hearing benefits, including no copay for preventive dental care up to a $2,000 annual limit and a $165 quarterly over-the-counter allowance. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, alongside annual allowances of $350 for eyewear and $1,500 for hearing aids. However, it is important to note that routine lab tests, outpatient X-rays, and transportation services are not covered under this plan.
Inpatient Hospital See details
Senior Care (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Senior Care (HMO I-SNP) covers outpatient services with no copay and a 20% coinsurance for ambulatory surgical center, outpatient substance abuse, and blood services. Outpatient hospital services carry no copay and up to a 20% coinsurance, while observation services require a $100 copay per stay and no coinsurance.
Partial Hospitalization See details
Senior Care (HMO I-SNP) covers partial hospitalization with no copay and a 20% coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Senior Care (HMO I-SNP) plan feature covered ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are not covered under this plan, including trips to plan-approved or any other health-related locations.
Emergency Services See details
Senior Care (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 3 days. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Senior Care (HMO I-SNP) covers primary care physician and opioid treatment services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, mental health and podiatry services feature no copay and 20% coinsurance, and chiropractic services are not covered.
Preventive Services See details
Senior Care (HMO I-SNP) partially covers preventive services with no copay and no coinsurance for covered care, such as kidney disease education and in-home support. However, annual physical exams, fitness benefits, health education, PERS, and in-home safety assessments are not covered.
Hearing Services See details
Senior Care (HMO I-SNP) offers partially covered hearing services, featuring routine hearing exams once a year with no copay and 20% coinsurance, alongside prescription hearing aids with no copay and no coinsurance up to a $1,500 annual limit. Fitting and evaluation for hearing aids, over-the-counter hearing aids, and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Senior Care (HMO I-SNP) covers vision services with no deductibles, offering yearly eye exams with no copay and 20% coinsurance for routine exams. Eyewear, including glasses and contacts, is also covered with no copay and no coinsurance up to a $350 yearly combined limit.
Dental Services See details
Senior Care (HMO I-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, alongside other preventive and comprehensive dental services with no copay and no coinsurance up to a $2,000 annual maximum. While many dental services like oral exams, cleanings, and restorative care are covered, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Senior Care (HMO I-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Senior Care (HMO I-SNP) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Senior Care (HMO I-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Senior Care (HMO I-SNP) partially covers diagnostic and radiological services, requiring prior authorization and featuring a 20% coinsurance with no copay for covered procedures. However, lab services and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Home Health Services are covered by the Senior Care (HMO I-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Senior Care (HMO I-SNP) plan, as all sub-services, including pulmonary, intensive cardiac, and supervised exercise therapy (SET) rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Senior Care (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance per admission, though prior authorization is required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Senior Care (HMO I-SNP) partially covers other services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $165 every three months via reimbursement. Acupuncture and meal benefits are not covered under this plan.
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