A non-government entity
American Health Advantage of Missouri (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Missouri (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 Missouri (HMO I-SNP) in 2026, please refer to our full plan details page.
American Health Advantage of Missouri (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Missouri (partial). This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that American Health Advantage of Missouri (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 Missouri (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 Missouri (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 Missouri (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.00. 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 $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 Missouri (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 covered medications before the plan begins to pay its share. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication levels, are not available for this plan. For the most accurate cost estimates, you should verify if your specific medications are covered under the plan's formulary.
Additional Benefits
The American Health Advantage of Missouri (HMO I-SNP) offers comprehensive coverage for essential medical services, typically featuring no copays and a 20% coinsurance for outpatient and specialist care. Primary care visits, preventive services, home health care, and skilled nursing facility stays for the first 100 days are fully covered with no copay and no coinsurance. Inpatient hospital stays require Medicare-defined cost shares with no copay or coinsurance, while emergency care, dialysis, and durable medical equipment require a 20% coinsurance and no copay. This plan also includes valuable supplemental benefits, such as up to 36 one-way transportation trips to health-related locations per year with no copay or coinsurance. Vision and hearing benefits feature no copays, offering a $300 annual eyewear allowance and up to $500 per ear annually for prescription hearing aids, though routine dental coverage is limited to Medicare-covered services with a 20% coinsurance. Additionally, Part B drugs are covered with no copay and coinsurance up to 20%, except for Part B insulin which has a flat $35 copay.
Inpatient Hospital See details
American Health Advantage of Missouri (HMO I-SNP) inpatient hospital services are partially covered, requiring prior authorization and charging Medicare-defined cost shares with no copay and no coinsurance. Additional days, upgrades, and non-Medicare-covered stays for acute or psychiatric treatments are not covered.
Outpatient Services See details
American Health Advantage of Missouri (HMO I-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for outpatient hospital, observation, and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by American Health Advantage of Missouri (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by American Health Advantage of Missouri (HMO I-SNP), featuring a 20% coinsurance and no copay for prior-authorized ground and air ambulance services. Transportation services are partially covered, offering up to 36 one-way trips per year to any health-related location with no copay or coinsurance, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency and urgently needed services are covered by American Health Advantage of Missouri (HMO I-SNP) with a 20% coinsurance and no copay, which is waived if you are admitted to the hospital within one day. Worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
American Health Advantage of Missouri (HMO I-SNP) provides primary care, telehealth, and opioid treatment services with no copay and no coinsurance. Other services, such as specialist visits, physical and occupational therapies, and psychiatric care, feature no copay and 0% to 20% coinsurance, though chiropractic services are only partially covered as routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by American Health Advantage of Missouri (HMO I-SNP) with no copay and no coinsurance for covered benefits, such as kidney disease education, in-home support, and glaucoma screenings. However, the plan does not cover annual physical exams, fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling services.
Hearing Services See details
American Health Advantage of Missouri (HMO I-SNP) covers hearing services, including annual routine exams with a 20% coinsurance and no copay, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $500 per ear yearly with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
American Health Advantage of Missouri (HMO I-SNP) partially covers vision services with no deductibles and a $300 annual maximum for eyewear. Routine eye exams (one per year) and contact lenses are covered with no copay and a 20% coinsurance, while eyeglasses and upgrades have no copay and no coinsurance; other eye exam services are not covered.
Dental Services See details
American Health Advantage of Missouri (HMO I-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Preventive and comprehensive dental services, including oral exams, cleanings, x-rays, orthodontics, and restorative services, are not covered.
Home Infusion bundled Services See details
American Health Advantage of Missouri (HMO I-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
American Health Advantage of Missouri (HMO I-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
American Health Advantage of Missouri (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 Missouri (HMO I-SNP) covers diagnostic and radiological services, subject to prior authorization. Outpatient diagnostic tests require a copay and 20% coinsurance, lab services have no copay, and radiological services, including X-rays, require 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by American Health Advantage of Missouri (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
American Health Advantage of Missouri (HMO I-SNP) covers some Cardiac Rehabilitation Services with no copay and prior authorization, but several key services are not covered in practice. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) 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 Missouri (HMO I-SNP) with no copay and no coinsurance for days 1 through 100, though prior authorization is required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
American Health Advantage of Missouri (HMO I-SNP) does not cover Other Services, meaning there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
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