A non-government entity
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 Pima and Santa Cruz 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:
Sign up for Banner Medicare Advantage Prime (HMO)
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
The Banner Medicare Advantage Prime (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay depending on the drug tier and pharmacy. 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 pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Banner Medicare Advantage Prime (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $275 copay for days 1-5, and no copay for days 6-90. Outpatient services, emergency services, and primary care visits are also covered with varying copays. Other services include hearing and vision coverage, dental services, home infusion, and medical equipment, with specific cost-sharing amounts for each. Additional benefits include coverage for ambulance services with a $250 copay, and diagnostic services with copays ranging from $0 to $200. The plan also covers home health services with no copay, and offers an over-the-counter benefit up to $55 every three months, along with a meal benefit. However, some services like outpatient blood services, podiatry, and several dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Banner Medicare Advantage Prime (HMO) plan. For days 1-5, there is a $275 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center services with a $200 copay, as well as outpatient substance abuse services with a $20 copay for individual and group sessions; however, outpatient blood services are not covered. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Banner Medicare Advantage Prime (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
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 $250 copay, with no coinsurance, while 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, but the copay is waived if you are admitted to the hospital within 24 hours. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage has a $120 copay and no coinsurance, but 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, physician specialist services with a $15 copay, mental health specialty services with a $25 copay for individual and group sessions, 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, 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 include coverage for Medicare-covered services, annual physical exams, and additional services such as fitness benefits and remote access technologies. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other 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. Prescription hearing aids are covered, with a maximum benefit of $1,000 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
The Banner Medicare Advantage Prime (HMO) plan covers vision services, including routine eye exams once per year with no copay or deductible, and eyewear, which includes a 20% coinsurance for contact lenses and a $25 copay for eyeglasses. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments. The plan does not cover orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Banner Medicare Advantage Prime (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Banner Medicare Advantage Prime (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a copay between $125 and $200, and Therapeutic Radiological Services have a copay of $60. Outpatient X-Ray Services are not covered.
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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Banner Medicare Advantage Prime (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $178 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and a meal benefit, but acupuncture, Dual Eligible SNPs, 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. The OTC benefit provides up to $55 every three months, and the meal benefit requires prior authorization.
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