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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 2025, 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 South Carolina (partial). This plan received an overall rating of 4 out of 5 stars in 2025.
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 $590.00 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:
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Drug Coverage
The Senior Care (HMO I-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2,000. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), your Part D costs will be $0.
Additional Benefits
The Senior Care (HMO I-SNP) plan offers a range of benefits, including inpatient hospital stays with a $295 copay for days 1-6, and no copay for days 7-90. Outpatient services have varying coinsurance, while emergency services have a $90 copay, and urgently needed services have a $40 copay. The plan also covers primary care, hearing, vision, dental, and home infusion services, along with durable medical equipment, and diagnostic and radiological services with coinsurance or copays. Preventive services are covered with no copay, and home health services are covered with no cost to the enrollee. There is also coverage for ambulance services and skilled nursing facilities with required prior authorization, and other services like OTC items with a maximum benefit of $190 every three months. However, some services, such as cardiac rehabilitation and certain outpatient services, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Senior Care (HMO I-SNP) plan. For days 1-6, there is a $295 copay, but there is no copay for days 7-90.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a coinsurance between 0% and 20%, and observation services with a $100 copay per stay. Ambulatory Surgical Center (ASC) Services and Individual/Group Sessions for Outpatient Substance Abuse are covered with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Senior Care (HMO I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $250 copay, and air ambulance services with 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Senior Care (HMO I-SNP) plan. For emergency services, there is a $90 copay and no coinsurance, while urgently needed services have a $40 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Senior Care (HMO I-SNP) plan covers Primary Care Physician services, Chiropractic services with 20% coinsurance, Occupational Therapy with a $20 copay, Physician Specialist services with a $25 copay, and Mental Health Specialty Services with 20% coinsurance. The plan also covers Podiatry Services with 20% coinsurance, Other Health Care Professional services with 20% coinsurance, Psychiatric Services with 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with a $20 copay, and Additional Telehealth Benefits with 0-20% coinsurance.
Preventive Services See details
The Senior Care (HMO I-SNP) plan covers Medicare-covered preventive services with no copay. However, annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20% and routine hearing exams once per year. Prescription hearing aids are covered with a maximum plan benefit of $1200 every year, but fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Senior Care (HMO I-SNP) plan covers vision services, including eye exams with a 20% coinsurance. The plan also covers eyewear, with a combined maximum benefit of $320 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Senior Care (HMO I-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a $1,500 maximum benefit per year. Oral exams, Dental X-Rays, and Prophylaxis (Cleaning) are covered with limitations on the number of visits, while Fluoride Treatment is covered every six months. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
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 under the Senior Care (HMO I-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0-20%.
Dialysis Services See details
Dialysis services are covered by the Senior Care (HMO I-SNP) plan. There is a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Senior Care (HMO I-SNP) plan covers Durable Medical Equipment with a 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home. Medical supplies and prosthetic devices are covered with a 20% coinsurance, while diabetic supplies are not covered, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services and Outpatient X-Ray Services are not covered; Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Senior Care (HMO I-SNP) plan with no copay or 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 Senior Care (HMO I-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
The Senior Care (HMO I-SNP) plan's other services benefit includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $190 every three months. Acupuncture, 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 are not covered.
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