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American Health Advantage of Idaho (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Idaho (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 Idaho (HMO I-SNP) in 2026, please refer to our full plan details page.
American Health Advantage of Idaho (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in South Idaho. 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 Idaho (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 Idaho (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 Idaho (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 Idaho (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:
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Drug Coverage
The American Health Advantage of Idaho (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your medications before your plan coverage begins to pay. Understanding this initial cost is a key step in evaluating your overall healthcare budget and pharmacy expenses. Specific drug coverage tier details, including individual copayments and coinsurance percentages, are currently not available for this plan. To determine how your specific prescriptions are covered and what your final costs will be, you should review the plan's formulary list.
Additional Benefits
The American Health Advantage of Idaho (HMO I-SNP) plan offers comprehensive coverage for core medical needs, often with low out-of-pocket costs. Members pay no copay and no coinsurance for primary care, telehealth, preventive services, home health care, and skilled nursing facility stays up to 100 days. Specialist visits, emergency care, outpatient services, and diagnostic tests generally feature no copay and a 20% coinsurance. The plan also includes valuable supplemental benefits, such as up to 32 one-way transportation trips per year with no copay and no coinsurance. Vision and hearing benefits are partially covered, offering routine exams with no copay and a 20% coinsurance, alongside annual allowances for hearing aids and eyewear. While Medicare-covered dental services require a 20% coinsurance and no copay, routine dental care and over-the-counter items are not covered.
Inpatient Hospital See details
American Health Advantage of Idaho (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, though Medicare-defined copays and prior authorization are required. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
American Health Advantage of Idaho (HMO I-SNP) covers outpatient services, including hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services, and there is no deductible for blood services.
Partial Hospitalization See details
American Health Advantage of Idaho (HMO I-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by American Health Advantage of Idaho (HMO I-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered, offering up to 32 one-way trips per year to plan-approved locations with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
American Health Advantage of Idaho (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within one day. Some worldwide emergency services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
American Health Advantage of Idaho (HMO I-SNP) covers primary care, telehealth, and opioid treatment services with no copay and no coinsurance. Specialist visits, psychiatric care, mental health, podiatry, and physical, occupational, and speech therapies are covered with no copay and 0% to 20% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services under the American Health Advantage of Idaho (HMO I-SNP) are covered with no copays and no coinsurance, including Medicare-covered preventive screenings, kidney disease education, and in-home support services. This benefit is partially covered, as annual physical exams, fitness benefits, health education, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by American Health Advantage of Idaho (HMO I-SNP) with no deductible, featuring a 20% coinsurance and no copay for one routine exam annually, no copay for fitting evaluations, and a copay for Medicare-covered exams. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 maximum per ear annually for up to two aids, but inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
American Health Advantage of Idaho (HMO I-SNP) provides partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered once per year with no copay and a 20% coinsurance, while eyewear is covered up to a $300 annual limit with no deductible, featuring no copays for all covered eyewear and no coinsurance except for contact lenses, which carry a 20% coinsurance.
Dental Services See details
American Health Advantage of Idaho (HMO I-SNP) partially covers dental services, providing coverage for Medicare-covered dental care with no copay and a 20% coinsurance. Routine, preventive, and comprehensive dental services, including oral exams, cleanings, x-rays, and orthodontic treatments, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by American Health Advantage of Idaho (HMO I-SNP) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the American Health Advantage of Idaho (HMO I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
American Health Advantage of Idaho (HMO I-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
American Health Advantage of Idaho (HMO I-SNP) covers diagnostic and radiological services with prior authorization, requiring a 20% minimum coinsurance for diagnostic tests, X-rays, and radiological services. Diagnostic procedures require a copayment, lab services have coinsurance with no copay, and all radiological services feature no copay.
Home Health Services See details
American Health Advantage of Idaho (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 not covered under the American Health Advantage of Idaho (HMO I-SNP) plan, as sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. These services require prior authorization and carry a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
American Health Advantage of Idaho (HMO I-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the American Health Advantage of Idaho (HMO I-SNP), as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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