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Banner Medicare Advantage Prime (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Banner Medicare Advantage Prime (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Banner Medicare Advantage Prime (HMO) in 2025, please refer to our full plan details page.
Banner Medicare Advantage Prime (HMO) is a HMO plan offered by Banner Health available for enrollment in 2025 to people living in Maricopa, Pinal Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Banner Medicare Advantage Prime (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 Banner Medicare Advantage Prime (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 Banner Medicare Advantage Prime (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 $2995.00 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:
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Drug Coverage
The Banner Medicare Advantage Prime (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions. For example, you'll pay a $5 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Banner Medicare Advantage Prime (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including substance abuse, have copays as well. Emergency services and primary care visits, including chiropractic and specialist services, also have copays. This plan includes coverage for hearing, vision, and dental services, each with specific cost-sharing arrangements. Hearing aids are covered up to a certain amount annually, and vision care includes routine exams and eyewear with a coinsurance or copay. Dental services involve coinsurance, and other services such as ambulance, home infusion, dialysis, medical equipment, and home health services have specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered with a $275 copay for days 1-5 and no copay for days 6-90. Additional days and non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, and ambulatory surgical center services, each with a $200 copay, as well as outpatient substance abuse services with a $20 copay for individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Banner Medicare Advantage Prime (HMO) with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Banner Medicare Advantage Prime (HMO) plan. Ground and air ambulance services have a $265 copay, and there is no coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $120 copay and no coinsurance. Urgently Needed Services are covered with no copay or coinsurance. Worldwide Emergency Coverage has a $120 copay and no coinsurance, while Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Banner Medicare Advantage Prime (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with no copay or coinsurance, physician specialist services with a $15 copay, and mental health specialty services with a $25 copay for individual and group sessions. This plan also covers other health care professional services with a $20 copay, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay or coinsurance, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $20 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams and additional preventive services, are covered. Fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, each covered once per year, as well as prescription hearing aids with a maximum benefit of $1,000 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Banner Medicare Advantage Prime (HMO) plan covers vision services including routine eye exams once per year, and eyewear. Eyewear has a 20% coinsurance for contact lenses, and a $25 copay for eyeglasses (lenses and frames), with a combined maximum plan benefit coverage of $250 every year. Eyeglass lenses and frames are not covered.
Dental Services See details
The Banner Medicare Advantage Prime (HMO) plan covers dental services with a 20% coinsurance. Other dental services are covered up to a maximum of $1000 per year, while Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), and Fluoride Treatment are covered with limitations on the number of visits per year. Orthodontic Services are covered under Diagnostic and Preventive Dental. Prosthodontics, removable has a coinsurance between 0% and 50%, while Prosthodontics, fixed has a 50% coinsurance. Implant Services and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Banner Medicare Advantage Prime (HMO). Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Banner Medicare Advantage Prime (HMO) plan. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, DME for use outside the home, Diabetic Supplies, and Medicare-covered Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under Banner Medicare Advantage Prime (HMO). Diagnostic Procedures/Tests, and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $125, and Therapeutic Radiological Services have a copay of at most $60.
Home Health Services See details
Home Health Services are covered by the Banner Medicare Advantage Prime (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Banner Medicare Advantage Prime (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Banner Medicare Advantage Prime (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $178 per day; additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a maximum benefit of $25.00 every three months, and a meal benefit that requires prior authorization. Acupuncture, 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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