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American Health Advantage of Utah (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Utah (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on American Health Advantage of Utah (HMO I-SNP) in 2025, please refer to our full plan details page.
American Health Advantage of Utah (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in North and Central Utah. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that American Health Advantage of Utah (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:
American Health Advantage of Utah (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 American Health Advantage of Utah (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 American Health Advantage of Utah (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.70. 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 $9350.00 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 American Health Advantage of Utah (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for the drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, your monthly premium for Part D is $54.70. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for your covered drugs.
Additional Benefits
The American Health Advantage of Utah (HMO I-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with coinsurance ranging from 0% to 20% depending on the service. The plan also covers primary care with no copay, along with preventive, hearing, vision, and dental services. This plan provides additional coverage for ambulance and transportation services, with no copay for transportation to health-related locations, but limited to 36 one-way trips per year. Other covered benefits include home health services, dialysis, medical equipment, and skilled nursing facility care, all with varying cost-sharing amounts.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare stays, and upgrades for both are not covered. The copay for both acute and psychiatric care is not specified in the provided information.
Outpatient Services See details
Outpatient services include outpatient hospital services and observation services, both with a 20% coinsurance, along with ambulatory surgical center services and outpatient substance abuse services, each with a coinsurance between 20% and 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the American Health Advantage of Utah (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 are covered, including ground and air ambulance services with a 20% coinsurance, as well as transportation services to any health-related location with no copay. Transportation services to a plan-approved health-related location is not covered, and transportation services to any health-related location is limited to 36 one-way trips per year.
Emergency Services See details
Emergency Services, including urgently needed services, are covered under the American Health Advantage of Utah (HMO I-SNP) plan with a 20% coinsurance. Worldwide emergency services, urgent coverage, and emergency transportation are not covered.
Primary Care See details
The American Health Advantage of Utah (HMO I-SNP) plan covers primary care physician services with no copay, chiropractic services with 20% coinsurance (except routine care), occupational therapy services with up to 20% coinsurance, physician specialist services with 0% to 20% coinsurance, mental health and psychiatric services with up to 20% coinsurance, podiatry services with up to 20% coinsurance and no copay, other health care professional services with up to 20% coinsurance, physical therapy and speech-language pathology services with 0% to 20% coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with no copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as additional preventive services that require a doctor referral, with a copay described in the plan details. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit are covered with no copay. The plan does not cover Annual Physical Exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, 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 Benefits, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefits, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing services are covered, including hearing exams and prescription hearing aids. Hearing exams have a 20% coinsurance for routine exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have no copay, and the plan covers up to $500 per year, per ear.
Vision Services See details
The American Health Advantage of Utah (HMO I-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and eyewear with a 20% coinsurance and a $300 combined maximum benefit. Routine eye exams have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services are covered, but orthodontic services are not. Medicare Dental Services have a 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the American Health Advantage of Utah (HMO I-SNP) plan, with prior authorization required. Medicare Part B insulin drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the American Health Advantage of Utah (HMO I-SNP) plan. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetics/Medical Supplies and Medical Supplies also have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the American Health Advantage of Utah (HMO I-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the American Health Advantage of Utah (HMO I-SNP) plan 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 under the American Health Advantage of Utah (HMO I-SNP) plan. Prior authorization is required for this benefit, but the plan does not cover any of the sub-services for Cardiac Rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by American Health Advantage of Utah (HMO I-SNP). There is no copay for days 1-100.
Other Services See details
Other Services are not covered by the American Health Advantage of Utah (HMO I-SNP) plan, including acupuncture, over-the-counter items, and meal benefits. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, private duty nursing services, and case management are also not covered.
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