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Erickson Advantage Guardian (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Erickson Advantage Guardian (HMO-POS I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Erickson Advantage Guardian (HMO-POS I-SNP) in 2025, please refer to our full plan details page.
Erickson Advantage Guardian (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA,NC. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Erickson Advantage Guardian (HMO-POS I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Erickson Advantage Guardian (HMO-POS 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 Erickson Advantage Guardian (HMO-POS 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 Erickson Advantage Guardian (HMO-POS I-SNP), 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. Additionally, this plan comes with a Part B Premium reduction of $0.50. You must continue to pay paying your reduced 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 $10000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $1000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 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 Erickson Advantage Guardian (HMO-POS I-SNP) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at standard pharmacies. Standard generic drugs have a $47 copay. For preferred brand drugs, you will pay a $100 copay at preferred and standard pharmacies. Non-preferred drugs have 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Erickson Advantage Guardian (HMO-POS I-SNP) plan offers comprehensive coverage with many services at no copay. This includes inpatient and outpatient hospital services, ambulance services, emergency services, primary care, preventive services, and home health services. Additionally, the plan covers services like hearing and vision exams, dental cleanings, and home infusion with no copay. The plan also provides coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities, with no copays for many of these services. While many services have no copay, some services, such as those related to cardiac rehabilitation, and medical equipment, have copays. However, the plan does not cover services such as worldwide emergency services, routine chiropractic care, and certain dental and vision services.
Inpatient Hospital See details
Inpatient Hospital benefits for the Erickson Advantage Guardian (HMO-POS I-SNP) plan include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, or outpatient blood services; individual and group sessions for outpatient substance abuse also have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Erickson Advantage Guardian (HMO-POS I-SNP) plan, with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Erickson Advantage Guardian (HMO-POS I-SNP) plan. Ground and Air Ambulance Services have no copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered with no copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Erickson Advantage Guardian (HMO-POS I-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, mental health specialty services, and additional telehealth benefits have no copay. Occupational therapy, physical therapy and speech-language pathology, and opioid treatment program services have a $0 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services. The plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services. Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, and Other Preventive Services are covered with no copay.
Hearing Services See details
Hearing Services includes hearing exams with no copay, but the plan does not cover fitting/evaluation for hearing aids, prescription hearing aids, or OTC hearing aids. Routine hearing exams are covered once per year.
Vision Services See details
Vision services for the Erickson Advantage Guardian (HMO-POS I-SNP) plan include eye exams with no copay, routine eye exams with no copay for 1 visit per year, and eyewear with no copay. Contact lenses are covered with no copay, eyeglass lenses have a copay between $0 and $153, and eyeglass frames are covered with no copay. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay, but orthodontics, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are not covered. Oral exams are limited to 2 visits per year, and dental x-rays are limited to 1 intraoral/panoramic every 3 years, 2 bitewing X-rays per year, and 1 bitewing X-ray per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Erickson Advantage Guardian (HMO-POS I-SNP) plan. There is no copay for Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Erickson Advantage Guardian (HMO-POS I-SNP) plan. There is no copay for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no coinsurance and no copay, with authorization required. Prosthetic Devices and Medical Supplies have no coinsurance and no copay. Diabetic Equipment has copays for Medicare-covered diabetes supplies and therapeutic shoes or inserts, with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have no copay, while Lab Services and Outpatient X-Ray Services also have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of at most $0.
Home Health Services See details
Home Health Services are covered by the Erickson Advantage Guardian (HMO-POS I-SNP) plan 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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and there is a copay for some services, as detailed in the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Erickson Advantage Guardian (HMO-POS I-SNP) plan, with no copay for days 1-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with no copay. However, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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