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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 2026, 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 5 out of 5 stars in 2026.
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.
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 $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) prescription drug plan features a $0 drug deductible, meaning your coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using a standard pharmacy or standard mail-order service. This makes managing your everyday prescriptions highly affordable right from the start. For higher-tier medications, costs are structured as a percentage of the drug cost. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 44% and 33% coinsurance respectively for standard pharmacy and mail-order fills. These clear cost-sharing percentages help you easily anticipate out-of-pocket expenses for your brand-name and specialty medications.
Additional Benefits
The Erickson Advantage Guardian (HMO-POS I-SNP) plan offers exceptionally low out-of-pocket costs, featuring no copays and no coinsurance for the vast majority of its covered medical services. This includes comprehensive coverage for inpatient and outpatient hospital stays, primary and specialist doctor visits, emergency services, and diagnostic testing. Additionally, members can access essential medical equipment, home health services, and preventive care at no cost, though prior authorization is required for many of these benefits. For routine care, the plan provides dental cleanings, annual hearing exams, and yearly vision exams with no copay or coinsurance. Vision benefits also include a one hundred and fifty dollar eyewear allowance every two years, while select over-the-counter items are covered with no copay. However, it is important to note that certain specialized services, such as routine chiropractic care, hearing aids, and non-emergency transportation, are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Erickson Advantage Guardian (HMO-POS I-SNP) with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. While unlimited additional acute days are covered at no cost, non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Erickson Advantage Guardian (HMO-POS I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and no coinsurance. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Erickson Advantage Guardian (HMO-POS I-SNP) with no copay and no coinsurance, although prior authorization is required for these services.
Ambulance and Transportation Services See details
Erickson Advantage Guardian (HMO-POS I-SNP) covers Medicare-covered ground and air ambulance services with no copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Erickson Advantage Guardian (HMO-POS I-SNP) covers emergency and urgently needed services with no copay and no coinsurance. While worldwide emergency services are technically covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Erickson Advantage Guardian (HMO-POS I-SNP) offers comprehensive primary care benefits with no copay and no coinsurance for primary care visits, specialist services, physical therapy, and mental health care. While most of these services are fully covered, chiropractic services are not covered in practice as both routine and other chiropractic services are excluded.
Preventive Services See details
Erickson Advantage Guardian (HMO-POS I-SNP) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, kidney disease education, glaucoma screenings, and home safety modifications. However, many additional preventive benefits, such as fitness programs, health education, and personal emergency response systems, are not covered.
Hearing Services See details
Hearing services covered by Erickson Advantage Guardian (HMO-POS I-SNP) include one routine hearing exam per year with no copay, no coinsurance, and no deductible, subject to prior authorization. Some prescription hearing aid services are covered, but fitting and evaluation, over-the-counter (OTC) hearing aids, and prescription hearing aids (including inner ear, outer ear, and over the ear types) are not covered.
Vision Services See details
Vision services are partially covered by Erickson Advantage Guardian (HMO-POS I-SNP) with no deductible and no coinsurance. Covered services include one routine eye exam annually with no copay (prior authorization required) and a $150 eyewear allowance every two years for contact lenses and frames with no copay, and eyeglass lenses with a $0 to $153 copay. Other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Erickson Advantage Guardian (HMO-POS I-SNP) partially covers dental services with no copay and no coinsurance for Medicare-covered dental care, oral exams, cleanings, fluoride, dental X-rays, and select preventive services. However, other diagnostic, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Erickson Advantage Guardian (HMO-POS I-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, which includes coverage for Part B insulin, chemotherapy, and other Part B drugs. Prior authorization is required and step therapy may apply to these covered services.
Dialysis Services See details
Dialysis services are covered under the Erickson Advantage Guardian (HMO-POS I-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Medical Equipment See details
Erickson Advantage Guardian (HMO-POS I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and no coinsurance. Prior authorization is required for these services, and there are no restrictions on preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Erickson Advantage Guardian (HMO-POS I-SNP) with no copay and no coinsurance, though prior authorization is required. This coverage includes lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Erickson Advantage Guardian (HMO-POS I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Erickson Advantage Guardian (HMO-POS I-SNP) with no copay and no coinsurance, subject to prior authorization. In practice, only some services are covered, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Erickson Advantage Guardian (HMO-POS I-SNP) with no copay and no coinsurance for days 1 through 100, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered. This benefit does not require a three-day inpatient hospital stay prior to admission.
Other Services See details
Other services are partially covered by Erickson Advantage Guardian (HMO-POS I-SNP), featuring over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC items include nicotine replacement therapy and naloxone, though not all CMS OTC list drugs are covered.
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