A non-government entity
Medical Associates SmartPlan (Cost)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medical Associates SmartPlan (Cost). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medical Associates SmartPlan (Cost) in 2026, please refer to our full plan details page.
Medical Associates SmartPlan (Cost) is a Cost plan offered by Medical Associates Clinic, P.C. available for enrollment in 2025 to people living in Grant, Crawford, Iowa, Lafayette Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Medical Associates SmartPlan (Cost) 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 Medical Associates SmartPlan (Cost).
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 Medical Associates SmartPlan (Cost), 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
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below 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:
Sign up for Medical Associates SmartPlan (Cost)
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
Prescription drugs are not covered by Medical Associates SmartPlan (Cost).
Additional Benefits
The Medical Associates SmartPlan (Cost) offers comprehensive coverage for core medical needs with no copay and no coinsurance for most covered services. This includes complete coverage for inpatient hospital stays, primary and specialist care, emergency services, dialysis, and home health care. Preventive services, routine annual physicals, and diagnostic hearing and vision exams are also available with no out-of-pocket costs to the member. While the plan offers generous zero-cost coverage for major medical services, it features significant exclusions for routine and supplemental benefits. Routine dental care, eyeglasses, hearing aids, and ground or air ambulance services are not covered under this plan. Additionally, there is no coverage for home infusion drugs, diabetic supplies, or over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Medical Associates SmartPlan (Cost) with no copay and no coinsurance for acute and psychiatric stays, which both include unlimited additional days. While non-Medicare-covered stays are covered, upgrades for acute inpatient hospital stays are not covered.
Outpatient Services See details
Medical Associates SmartPlan (Cost) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. Outpatient substance abuse services are not covered in practice, as both individual and group sessions are excluded from coverage.
Partial Hospitalization See details
Partial hospitalization is covered under the Medical Associates SmartPlan (Cost) with no copay and no coinsurance.
Ambulance and Transportation Services See details
Medical Associates SmartPlan (Cost) provides coverage for some ambulance and transportation services with no copay and no coinsurance. However, ground ambulance, air ambulance, and transportation to plan-approved or any health-related locations are not covered.
Emergency Services See details
Medical Associates SmartPlan (Cost) covers emergency services, urgently needed services, and worldwide emergency care with no copay and no coinsurance. Worldwide coverage includes emergency transportation, urgent care, and emergency services with no maximum benefit limit.
Primary Care See details
Primary care benefits under the Medical Associates SmartPlan (Cost) are covered with no copay and no coinsurance, including primary care, specialist, therapy, podiatry, and opioid treatment. Chiropractic, mental health, and psychiatric services also feature no copay or coinsurance, though telehealth, other chiropractic services, and individual or group therapy sessions are not covered.
Preventive Services See details
Preventive services are covered by Medical Associates SmartPlan (Cost) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Under additional preventive services, some services are covered, but sub-services such as health education, fitness, weight management, alternative therapies, PERS, nutritional/dietary benefits, and caregiver support are not covered.
Hearing Services See details
Hearing Services are partially covered under the Medical Associates SmartPlan (Cost), which features diagnostic hearing exams with no copay and no coinsurance. However, routine hearing exams, hearing aid fittings and evaluations, OTC hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Medical Associates SmartPlan (Cost) partially covers vision services, offering one routine eye exam per year with no copay, no coinsurance, and no deductible. Other eye exam services and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Medical Associates SmartPlan (Cost) partially covers dental services, providing Medicare-covered dental care with no copay and no coinsurance. However, other dental services—including oral exams, cleanings, x-rays, fluoride treatments, restorative care, and orthodontics—are not covered.
Home Infusion bundled Services See details
Medical Associates SmartPlan (Cost) does not cover Home Infusion bundled Services, meaning there is no coverage for Medicare Part B insulin, chemotherapy, radiation, or other Part B drugs under this benefit.
Dialysis Services See details
Medical Associates SmartPlan (Cost) covers dialysis services with no copay and no coinsurance. This benefit ensures you can receive necessary kidney dialysis treatments without worrying about copayments or coinsurance fees.
Medical Equipment See details
Medical Associates SmartPlan (Cost) covers durable medical equipment with no copay and no coinsurance. For other medical equipment benefits, some services are covered, but prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Medical Associates SmartPlan (Cost) covers some diagnostic and radiological services with no copay and no coinsurance, though diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home health services are covered by Medical Associates SmartPlan (Cost) with no copay and no coinsurance, allowing you to receive essential care in your home at no cost.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Medical Associates SmartPlan (Cost) with no copay and no coinsurance, though only some services are covered. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Medical Associates SmartPlan (Cost) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance. This benefit includes up to 30 additional days of coverage per benefit period beyond standard Medicare limits, though a prior three-day inpatient hospital stay is required for admission.
Other Services See details
Medical Associates SmartPlan (Cost) covers Other Services, but in practice, some services are covered while acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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