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 2025, 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 2025.
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 $51.00. 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 $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 Missouri (HMO I-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay costs based on the drug tier, but the specific amounts are not provided in this summary. 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, you will pay $51 per month for your Part D premium.
Additional Benefits
The American Health Advantage of Missouri (HMO I-SNP) plan offers a variety of benefits with varying cost-sharing. Many services, like primary care, home health, and hearing exams, have no copay, while others, such as outpatient services, emergency services, and vision services, require a 20% coinsurance. The plan covers a range of services, including inpatient and outpatient hospital care, partial hospitalization, ambulance and transportation, and preventive services. Additionally, it provides coverage for hearing aids, vision, dental, and dialysis services. However, it's important to note that some services, like cardiac rehabilitation and certain "other services", are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but the copay is not specified. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by American Health Advantage of Missouri (HMO I-SNP). 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, each with a 20% coinsurance. Transportation Services to any health-related location are covered with no copay, but transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the American Health Advantage of Missouri (HMO I-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, but no copay. Worldwide Emergency Services are not covered.
Primary Care See details
The American Health Advantage of Missouri (HMO I-SNP) plan covers primary care physician services with no copay, and chiropractic services with 20% coinsurance. Occupational Therapy Services are covered, with a coinsurance between 0% and 20%. Physician Specialist Services and Physical Therapy and Speech-Language Pathology Services are covered with 0% to 20% coinsurance. Mental Health Specialty Services and Psychiatric Services have a coinsurance between 0% and 20% for individual and group sessions. Podiatry Services are covered, and Routine Foot Care has a coinsurance between 0% and 20%. Other Health Care Professional services are covered with a coinsurance between 0% and 20%. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, and additional preventive services. 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, and counseling services are not covered. Other covered services include kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. In-home support services are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Routine hearing exams have no copay and a 20% coinsurance, and fitting/evaluation for hearing aids has no copay and no coinsurance. Prescription hearing aids (all types) have no copay and are limited to 2 per year, while inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
The American Health Advantage of Missouri (HMO I-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental Services are partially covered by the American Health Advantage of Missouri (HMO I-SNP) plan. Medicare Dental Services are covered with a 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the American Health Advantage of Missouri (HMO I-SNP) plan. The coinsurance for this service is 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay. However, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, with a minimum coinsurance of 20%. Lab Services have 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the American Health Advantage of Missouri (HMO I-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the American Health Advantage of Missouri (HMO I-SNP) plan, but require prior authorization. There is no copay for days 1-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the American Health Advantage of Missouri (HMO I-SNP) plan, including acupuncture, over-the-counter items, meal benefits, and various other services. No authorization or referrals are required for these services.
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