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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 Yuma County. 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 will pay a copay for your prescriptions. For example, you will 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 your Part D 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 coverage for a variety of services with varying costs. Inpatient hospital stays have a $275 copay for the first five days, and no copay for days 6-90. Outpatient services, emergency services, and ambulance services are covered with copays ranging from $120 to $265. The plan also covers primary care, preventive services, hearing, vision, and dental, with costs depending on the specific service. Diagnostic and radiological services also have associated copays. Additionally, home health services, skilled nursing facilities, and medical equipment are covered, as well as home infusion bundled services.
Inpatient Hospital See details
Inpatient hospital stays, both acute and psychiatric, are covered, with a copay of $275 for days 1-5, and no copay for days 6-90. Additional days and non-Medicare covered stays for both acute and psychiatric inpatient hospital stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services each have a $200 copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay between $20 and $20. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Banner Medicare Advantage Prime (HMO) plan. Ground and Air Ambulance Services have a $265 copay, and there is no coinsurance, while other transportation services are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, are covered under the Banner Medicare Advantage Prime (HMO) plan. Emergency Services have a $120 copay and no coinsurance, while Worldwide Emergency Coverage also has a $120 copay and no coinsurance. 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, physician specialist services with a $15 copay, and mental health specialty services with a $25 copay for individual and group sessions. The plan also covers other health care professional services with a minimum and maximum copay of $20, psychiatric services with a $25 copay for individual and group sessions, and physical and speech therapy with no copay. Additional telehealth benefits are covered with a copay from $0 to $25, and opioid treatment program services are covered with a minimum and maximum copay of $20.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services are covered. Additional preventive services such as health education, in-home safety assessments, and several others 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 plan benefit of $1000 every year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and 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. Eyewear is covered with 20% coinsurance for contact lenses and a $25 copay for eyeglasses, and a combined maximum benefit of $250 per year. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services has a 20% coinsurance for Medicare Dental Services. Other Dental Services are covered up to a maximum of $1000 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. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Banner Medicare Advantage Prime (HMO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical equipment is covered, with Durable Medical Equipment (DME) and Prosthetic Devices having a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Medical Supplies have a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $125 and $200, and Therapeutic Radiological Services have a $60 copay. 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. 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. Specifically, 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 are not covered.
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; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit. 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. The OTC benefit has a maximum of $140.00 every three months.
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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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