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PruittHealth Premier (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PruittHealth Premier (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PruittHealth Premier (HMO I-SNP) in 2025, please refer to our full plan details page.
PruittHealth Premier (HMO I-SNP) is a HMO I-SNP plan offered by UNICO Services, Inc. available for enrollment in 2025 to people living in NC (Partial). This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that PruittHealth Premier (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PruittHealth Premier (HMO 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 PruittHealth Premier (HMO 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 PruittHealth Premier (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 PruittHealth Premier (HMO I-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D drugs will be $51.20. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Note that the specific costs for drugs in each tier are not provided in this summary.
Additional Benefits
The PruittHealth Premier (HMO I-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient hospital services, with varying coinsurance amounts. The plan also covers emergency services with a $90 copay, primary care, and home health services with no copay. Additional benefits include coverage for hearing and vision services, such as routine hearing exams and eye exams with coinsurance, as well as coverage for prescription hearing aids and eyewear. Dental services are partially covered. Other covered services include ambulance, transportation, and medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the PruittHealth Premier (HMO I-SNP) plan. The cost sharing details, including coinsurance and deductible information, are available elsewhere in the plan details. Additional days, non-Medicare covered stays, and upgrades are not covered for either Acute or Psychiatric inpatient hospital services.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance, and Observation Services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a coinsurance of 20% for both individual and group sessions. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PruittHealth Premier (HMO I-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the PruittHealth Premier (HMO I-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the PruittHealth Premier (HMO I-SNP) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a 20% coinsurance and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are not covered.
Primary Care See details
The PruittHealth Premier (HMO I-SNP) plan covers primary care physician services, chiropractic services with a 20% coinsurance and $30 copay for routine care (12 visits per year), occupational therapy services with 5% coinsurance, physician specialist services with a 20% coinsurance, mental health specialty services with a 20% coinsurance, podiatry services with a 20% coinsurance (6 visits per year), other health care professional services with a 20% coinsurance, psychiatric services with a 20% coinsurance, physical therapy and speech-language pathology services with a 5% coinsurance, additional telehealth benefits with 0% - 20% coinsurance, and opioid treatment program services.
Preventive Services See details
Preventive Services are covered under the PruittHealth Premier (HMO I-SNP) plan. However, the annual physical exam, 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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services with the PruittHealth Premier (HMO I-SNP) plan include routine hearing exams with a coinsurance of 20% and fitting/evaluation for hearing aids with no coinsurance. Prescription hearing aids (all types) are covered, with a maximum plan benefit of $4,000 every two years. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including eye exams with a 20% coinsurance. This plan also covers eyewear, with a combined maximum benefit of $300 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are partially covered by the PruittHealth Premier (HMO I-SNP) plan, with Medicare Dental Services subject to a 20% coinsurance. Orthodontic, Restorative, Adjunctive General, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with 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 by the PruittHealth Premier (HMO I-SNP) plan. You will be responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the PruittHealth Premier (HMO I-SNP) plan. Durable Medical Equipment has a 20% coinsurance, and no copay, while medical supplies, prosthetic devices, and diabetic supplies and therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the PruittHealth Premier (HMO I-SNP) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the PruittHealth Premier (HMO I-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $135.00 per month, but Acupuncture, Meal Benefit, 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. Nicotine Replacement Therapy (NRT) and Naloxone coverage are not offered as a Part C OTC benefit.
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