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Spirit (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Spirit (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Spirit (HMO-POS) in 2026, please refer to our full plan details page.
Spirit (HMO-POS) is a HMO-POS plan offered by Sanford Health available for enrollment in 2025 to people living in Central, North, Northeast, West & South Central WI. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Spirit (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Spirit (HMO-POS).
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 Spirit (HMO-POS), 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $1500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $1500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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
Prescription drugs are not covered by Spirit (HMO-POS).
Additional Benefits
The Spirit (HMO-POS) Medicare plan offers essential medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, home health services, and partial hospitalization. For more intensive care, inpatient hospital stays require a $250 copay with no coinsurance, while emergency room visits have a $140 copay that is waived upon admission. Outpatient hospital services range from no copay up to a $100 copay, and skilled nursing facility stays offer no copay for the majority of covered days. Specialist visits and diagnostic eye exams require copays up to $25, while routine vision and Medicare-covered dental services like cleanings and oral exams are available with no copay. Prescription hearing aids are covered with a $500 copay, and diagnostic radiological services carry a $150 copay. Additionally, the plan provides an over-the-counter benefit of up to $30 every three months with no copay, helping members save on everyday wellness items.
Inpatient Hospital See details
Spirit (HMO-POS) inpatient hospital care is partially covered, requiring a $250 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions, with prior authorization required. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Spirit (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $100 copay for outpatient hospital and observation services and a $25 copay for outpatient substance abuse sessions. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Spirit (HMO-POS) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Spirit (HMO-POS), with transportation to plan-approved or any health-related locations not covered. Medicare-covered ground and air ambulance services require prior authorization and have a $175 copay with no coinsurance.
Emergency Services See details
Spirit (HMO-POS) covers emergency services with a $140 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed and worldwide emergency services are also covered with no coinsurance, featuring copays ranging from no copay to $25 for urgent care, $140 for worldwide emergency care, and $175 for worldwide emergency transportation.
Primary Care See details
Primary Care benefits under the Spirit (HMO-POS) plan are partially covered, offering primary care physician visits with no copay and no coinsurance, while specialists and therapy services have copays ranging from $20 to $25 with no coinsurance. Podiatry services are not covered, and some services like opioid treatment require a 20% coinsurance alongside copays up to $25.
Preventive Services See details
Preventive services under Spirit (HMO-POS) are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings, while home and bathroom safety devices require a 20% coinsurance. However, several additional services are not covered, including in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Spirit (HMO-POS), featuring hearing exams with a $25 copay and no coinsurance, which includes one routine exam annually and unlimited fitting evaluations. Prescription hearing aids are partially covered with a $500 copay and no coinsurance for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Spirit (HMO-POS) covers vision services with no deductibles or coinsurance, featuring a $25 copay for Medicare-covered and diagnostic eye exams and no copay for routine exams. Eyewear is partially covered with no copay up to a $175 annual maximum, though contact lenses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Spirit (HMO-POS) dental services are partially covered, providing Medicare-covered dental, oral exams, cleanings, and X-rays with no copay and no coinsurance. However, other preventive dental, restorative services, endodontics, periodontics, prosthodontics, implants, oral surgery, adjunctive general services, and orthodontics are not covered.
Home Infusion bundled Services See details
Spirit (HMO-POS) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy and other drugs require a coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin is also covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Spirit (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Spirit (HMO-POS) covers medical equipment with no copays, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Spirit (HMO-POS) plan with no coinsurance, though prior authorization is required. While diagnostic radiological services require a $150.00 copay and therapeutic radiological services require a $25.00 copay, diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Spirit (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Spirit (HMO-POS) does not cover Cardiac Rehabilitation Services, as all related sub-services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, are not covered.
Skilled Nursing Facility (SNF) See details
Spirit (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 6 and days 21 to 100, and a $20 daily copay for days 7 to 20. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Spirit (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to $30 every three months, and Part B home infusion services with no copay and 0% to 20% coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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