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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 South Carolina (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 $35.70. 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. This means you will need to pay this amount out-of-pocket for your medications before the plan's coverage begins to pay. Specific details regarding drug tiers, copays, and coinsurance are not available for this plan. For the most accurate cost estimates, you should verify how your specific medications are categorized under this plan's formulary.
Additional Benefits
The PruittHealth Premier (HMO I-SNP) plan offers comprehensive medical coverage with many essential services featuring no copays. Beneficiaries pay no copay or coinsurance for inpatient hospital stays, primary care visits, home health services, and skilled nursing facility care. For other medical needs, specialist visits require a $35 copay, outpatient hospital services carry a 20% coinsurance, and emergency room visits have a $90 copay. Additional benefits include a $300 annual eyewear allowance and up to $4,000 every two years for prescription hearing aids with no copays or coinsurance. The plan also covers up to 24 free one-way transportation trips per year and provides a monthly allowance of $170 with no copay for over-the-counter health items. Diagnostic services, medical equipment, and dialysis are generally covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
PruittHealth Premier (HMO I-SNP) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, subject to Medicare-defined deductibles and prior authorization. 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, including outpatient hospital services with a 20% coinsurance and observation services with a $100 copay per stay. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are covered with no copay and a 20% coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
PruittHealth Premier (HMO I-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
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, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
PruittHealth Premier (HMO I-SNP) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within three days, and urgently needed services with a 20% coinsurance (up to $40 per visit) and no copay. For worldwide emergency services, some services are covered, but worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
PruittHealth Premier (HMO I-SNP) provides primary care, occupational, physical, and speech therapies, and opioid treatment with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Mental health, psychiatric, and routine podiatry services feature no copay and 20% coinsurance, telehealth is available with no copay and 0% to 20% coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by PruittHealth Premier (HMO I-SNP), offering Medicare-covered preventive services, kidney disease education, and select screenings with no copay and no coinsurance. However, several services are not covered under this benefit, including annual physical exams, fitness benefits, health education, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by PruittHealth Premier (HMO I-SNP), offering hearing exams with no copay and 20% coinsurance for routine visits, and prescription hearing aids with no copay or coinsurance up to a $4,000 limit every two years. OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services covered under the PruittHealth Premier (HMO I-SNP) plan include annual routine eye exams and glaucoma testing with no copay, no deductible, and a 20% coinsurance for routine exams. Covered eyewear, including contacts, frames, and lenses, features 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 Medicare-covered dental care with no copay and a 20% coinsurance, subject to prior authorization. Preventive and comprehensive dental services—including oral exams, cleanings, x-rays, restorative services, and orthodontics—are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PruittHealth Premier (HMO I-SNP) with no copay, requiring prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance of no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and a coinsurance of no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the PruittHealth Premier (HMO I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PruittHealth Premier (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
PruittHealth Premier (HMO I-SNP) partially covers diagnostic and radiological services with 20% coinsurance and no copayment, though prior authorization is required. Covered services include diagnostic procedures, outpatient X-rays, and therapeutic and diagnostic radiological services, while lab services are not covered.
Home Health Services See details
PruittHealth Premier (HMO I-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the PruittHealth Premier (HMO I-SNP) plan with no copay and prior authorization, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
PruittHealth Premier (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. This benefit allows for admission without requiring a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PruittHealth Premier (HMO I-SNP) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $170 per month. Acupuncture, meal benefits, Nicotine Replacement Therapy, and Naloxone are not covered, and unused monthly OTC balances do not carry forward.
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