A non-government entity
Troy Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Troy Medicare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Troy Medicare (HMO) in 2026, please refer to our full plan details page.
Troy Medicare (HMO) is a HMO plan offered by Troy Holdings, Inc. available for enrollment in 2025 to people living in Piedmont and Mountain Regions. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Troy Medicare (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Troy Medicare (HMO).
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 Troy Medicare (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3950.00 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 Troy Medicare (HMO)
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 Troy Medicare (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies and Tier 6 vaccines at both preferred and standard pharmacies. For Tier 2 generic drugs, copays start at $5 at preferred pharmacies and $20 at standard pharmacies for a one-month supply. Tier 3 preferred brand drugs cost $25 at preferred pharmacies and $40 at standard pharmacies for a one-month supply. Tier 4 non-preferred drugs require a $100 copay, while Tier 5 specialty drugs incur a 33% coinsurance regardless of the pharmacy chosen. Opting for preferred pharmacies and filling multi-month prescriptions offers the lowest out-of-pocket costs on this plan.
Additional Benefits
Troy Medicare (HMO) offers affordable coverage for essential healthcare services, featuring no copays for primary care, specialist visits, telehealth, and urgent care. Inpatient hospital stays require a $400 daily copay for the first five days and no copay for days six through 90, while outpatient hospital services range from a $150 to $350 copay. Emergency room visits carry a $110 copay, which is waived if you are admitted, and ground ambulance services require a $255 copay. The plan also includes strong supplemental benefits with no copays for routine hearing and vision exams, alongside allowances for prescription hearing aids and eyewear. Preventive and comprehensive dental care is covered with no copay up to a $3,000 annual limit, while medical equipment and dialysis require a 20% coinsurance. Additionally, members can take advantage of a $20 monthly over-the-counter reimbursement and up to 24 free one-way trips to approved health locations per year.
Inpatient Hospital See details
Inpatient hospital services are covered by Troy Medicare (HMO) with no coinsurance, requiring a $400 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. This benefit is partially covered because upgrades and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
Troy Medicare (HMO) covers outpatient services with no coinsurance, requiring copays of $150 to $350 for outpatient hospital and observation services and $350 for ambulatory surgical center services, with prior authorization required for both. Outpatient substance abuse sessions incur a $45 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Troy Medicare (HMO) covers partial hospitalization services with an $85.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Troy Medicare (HMO) covers ground ambulance services with a $255 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Troy Medicare (HMO) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, but worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
Troy Medicare (HMO) covers primary care, specialist visits, telehealth, and opioid treatment with no copay and no coinsurance, while physical, occupational, and speech therapies require a $20 copay and no coinsurance. Mental health and psychiatric services have a $45 copay and no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services under Troy Medicare (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, excluding sub-services such as medical nutrition therapy, weight management programs, alternative therapies, and in-home safety assessments.
Hearing Services See details
Hearing Services are partially covered by Troy Medicare (HMO), offering routine exams and fitting evaluations with no copay and no coinsurance up to an $825 maximum every two years. While up to two prescription hearing aids are covered every two years with no copay and no coinsurance, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Troy Medicare (HMO) with no copay and no coinsurance, including one routine eye exam per year up to $50 and a $200 annual maximum for one pair of contact lenses or complete eyeglasses. Other eye exam services, separate eyeglass frames or lenses, and upgrades are not covered.
Dental Services See details
Troy Medicare (HMO) provides partially covered dental services, including Medicare-covered dental with no copay and 20% coinsurance, and preventive and comprehensive dental care with no copay and no coinsurance up to a $3,000 annual limit. Some sub-services are not covered, specifically other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Troy Medicare (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, although prior authorization is required. Under this plan, Medicare Part B insulin has a $0.00 to $35.00 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Troy Medicare (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Troy Medicare (HMO) with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered, as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Troy Medicare (HMO), as lab services are not covered. Covered diagnostic procedures and outpatient X-rays require a $10 copay with no coinsurance, diagnostic radiological services require a $50 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Troy Medicare (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Troy Medicare (HMO) covers Cardiac Rehabilitation Services with no coinsurance and required prior authorization, but only some services are covered. Standard cardiac rehabilitation ($35 copay), intensive cardiac rehabilitation ($65 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Troy Medicare (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $214 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Troy Medicare (HMO) partially covers other services, offering an over-the-counter (OTC) benefit of up to $20 per month via reimbursement with no copay and no coinsurance. Other supplemental services, including acupuncture, meal benefits, nicotine replacement therapy, and naloxone, are not covered under this plan.
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