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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 2026, 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 2026.
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 $36.20. 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 $615.00 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 $9250.00 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) prescription drug coverage includes an annual drug deductible of $615. Beneficiaries must pay this deductible amount out-of-pocket for covered medications before the plan starts covering prescription costs. Detailed drug tier coverage, copayments, and coinsurance information are currently not available for this specific plan. To fully understand your potential out-of-pocket costs with the PruittHealth Premier (HMO I-SNP) plan, it is recommended to verify how your specific medications are covered. Since tier-specific copay details are missing, checking the plan's formulary directly will help you estimate your yearly drug expenses. This ensures you make an informed decision regarding your Medicare drug coverage.
Additional Benefits
The PruittHealth Premier (HMO I-SNP) plan offers medical coverage with no copay for inpatient hospital stays, primary care visits, home health services, and skilled nursing facility care. Specialist visits require a $35 copay, while outpatient hospital services, diagnostic tests, and durable medical equipment generally feature a 20% coinsurance and no copay. Emergency room visits require a $90 copay, and urgently needed services carry a 20% coinsurance up to $40. Additional perks include up to 24 one-way transportation trips per year and an over-the-counter reimbursement of up to $140 per month with no copay. Routine vision and hearing exams are covered with no copay and a 20% coinsurance, alongside a $300 annual eyewear allowance and up to $4,000 every two years for prescription hearing aids with no copay. Dental coverage is limited to Medicare-covered services, which require a 20% coinsurance and no copay.
Inpatient Hospital See details
PruittHealth Premier (HMO I-SNP) covers inpatient acute and psychiatric hospital stays with no copay, subject to Medicare-defined deductibles and coinsurance with prior authorization required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
PruittHealth Premier (HMO I-SNP) covers outpatient services, offering outpatient hospital, ambulatory surgical center, substance abuse, and blood services with no copay and a 20% coinsurance. Medicare-covered observation services instead require a $100 copay per stay and no coinsurance, and prior authorization is required for most of these outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered by PruittHealth Premier (HMO I-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
PruittHealth Premier (HMO I-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance, providing up to 24 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
PruittHealth Premier (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a 20% coinsurance (up to $40) and no copay, with cost-sharing waived if admitted to the hospital within three days. Although some worldwide emergency services are covered, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
PruittHealth Premier (HMO I-SNP) covers primary care, occupational, physical, speech-language, and opioid treatment services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Mental health, psychiatric, podiatry, and telehealth services are covered with no copay and up to 20% coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by PruittHealth Premier (HMO I-SNP) with no copay and no coinsurance for Medicare-covered preventive services, kidney disease education, and other screenings. However, the plan does not cover an annual physical exam or additional services such as health education, fitness benefits, in-home safety assessments, and personal emergency response systems. No referrals are required for any of the covered preventive services.
Hearing Services See details
PruittHealth Premier (HMO I-SNP) hearing services are partially covered, offering routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are covered up to $4,000 every two years with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
PruittHealth Premier (HMO I-SNP) covers vision services, offering annual routine eye exams and glaucoma testing with no copay and a 20% coinsurance. Covered eyewear, including contacts and eyeglasses, has no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $300 per year.
Dental Services See details
PruittHealth Premier (HMO I-SNP) partially covers dental services, offering coverage only for Medicare-covered dental care with no copay and a 20% coinsurance, which requires prior authorization. Routine and comprehensive dental services, including exams, cleanings, x-rays, preventive care, and orthodontic services, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by PruittHealth Premier (HMO I-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by PruittHealth Premier (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by PruittHealth Premier (HMO I-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic services. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the PruittHealth Premier (HMO I-SNP) plan, requiring prior authorization, no copay, and a 20% coinsurance for covered diagnostic procedures, radiological services, and outpatient X-rays. Lab services are not covered under this plan.
Home Health Services See details
Home Health Services are covered by PruittHealth Premier (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PruittHealth Premier (HMO I-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization required, but only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
PruittHealth Premier (HMO I-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan allows SNF admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by PruittHealth Premier (HMO I-SNP), which features an over-the-counter (OTC) benefit of up to $140 per month via reimbursement with no copay and no coinsurance. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
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