A non-government entity
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 2026, 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 2026.
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 $37.60. 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 $615.00 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 $9250.00 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 American Health Advantage of Utah (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 American Health Advantage of Utah (HMO I-SNP) Medicare plan features an annual drug deductible of $615 for its prescription drug coverage. This deductible represents the amount you must pay out-of-pocket for your medications before the plan begins to pay its share. Specific drug coverage tier details, including exact copayments and coinsurance rates for different drug tiers, are currently unavailable for this plan. To determine your actual out-of-pocket costs, you will need to review the plan's specific formulary to see how your personal medications are classified.
Additional Benefits
The American Health Advantage of Utah (HMO I-SNP) offers comprehensive medical coverage with many services requiring no copay. Beneficiaries enjoy primary care visits, home health services, and skilled nursing facility stays for days 1 through 100 with no copay and no coinsurance. Outpatient hospital care, emergency services, and specialist visits generally feature no copay but require a 20% coinsurance. This plan also includes routine transportation for up to 34 one-way trips per year with no copay and no coinsurance. Vision and hearing benefits provide coverage for annual exams and hardware, including up to $500 for hearing aids and $300 for eyewear, with no copay and 0% to 20% coinsurance. However, routine dental care, fitness benefits, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by American Health Advantage of Utah (HMO I-SNP) with no coinsurance, though prior authorization is required and Medicare-defined cost shares apply. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
American Health Advantage of Utah (HMO I-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
American Health Advantage of Utah (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by American Health Advantage of Utah (HMO I-SNP), featuring a 20% coinsurance and no copay for prior-authorized ground and air ambulance services. Additionally, the plan offers routine transportation to any health-related location with no copay and no coinsurance, limited to 34 one-way trips per year.
Emergency Services See details
Emergency services are covered by American Health Advantage of Utah (HMO I-SNP) with a 20% coinsurance and no copay (up to $115 per visit), which counts toward the plan deductible and is waived if admitted to the hospital within one day. Urgently needed services also require a 20% coinsurance and no copay (up to $40), but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Primary care benefits through American Health Advantage of Utah (HMO I-SNP) feature no copay and no coinsurance for primary care physician visits, telehealth, and opioid treatment. Specialist visits, physical, occupational, and speech therapies, mental health, psychiatric, and podiatry services are covered with no copay and 0% to 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
American Health Advantage of Utah (HMO I-SNP) partially covers preventive services with no copay and no coinsurance for covered services like kidney disease education, glaucoma screenings, and in-home support. However, several sub-services are not covered, including annual physical exams, fitness benefits, health education, and personal emergency response systems.
Hearing Services See details
American Health Advantage of Utah (HMO I-SNP) partially covers hearing services, offering one annual routine hearing exam with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 annually with no copay or coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
American Health Advantage of Utah (HMO I-SNP) provides partially covered vision services with no deductibles, including one annual routine eye exam with no copay and 20% coinsurance, while other eye exams are not covered. Eyewear is covered up to a $300 annual limit, featuring contact lenses with no copay and 20% coinsurance, and eyeglasses, lenses, frames, and upgrades with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by American Health Advantage of Utah (HMO I-SNP), which offers Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, and restorative treatments, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by American Health Advantage of Utah (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by American Health Advantage of Utah (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
American Health Advantage of Utah (HMO I-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance, though prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
American Health Advantage of Utah (HMO I-SNP) covers diagnostic and radiological services, with prior authorization required. Lab services feature no copay, diagnostic procedures require a copayment and 20% coinsurance, and radiological services, therapeutic radiology, and outpatient X-rays carry no copay and a 20% coinsurance.
Home Health Services See details
American Health Advantage of Utah (HMO I-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay under the American Health Advantage of Utah (HMO I-SNP) plan, though prior authorization is required. However, specific sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by American Health Advantage of Utah (HMO I-SNP) with no copay and no coinsurance for days 1 through 100, and no prior three-day hospital stay is required. Prior authorization is required for this benefit, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the American Health Advantage of Utah (HMO I-SNP) plan. Acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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