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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 South Carolina (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 $46.60. 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 defined standard for drug coverage. You will pay a deductible of $590.00 before the plan begins to pay for your prescriptions. If you qualify for the low-income subsidy, your monthly premium for Part D will be $46.60. After your deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you will enter the next coverage phase.
Additional Benefits
The PruittHealth Premier (HMO I-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying cost-sharing amounts such as copays and coinsurance. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services. You will pay a 20% coinsurance for many of these services. Additional benefits include coverage for ambulance services, home health, and medical equipment. The plan also provides an over-the-counter (OTC) allowance of $105.00 per month. Some services require prior authorization.
Inpatient Hospital See details
The PruittHealth Premier (HMO I-SNP) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. The plan states that the cost sharing, including coinsurance and deductible, is defined by Medicare. Additional days for inpatient hospital, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance, and Observation Services with a $100 copay per stay. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with coinsurance of 20% for individual and group sessions, but 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, including ground and air ambulance services, each with a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the PruittHealth Premier (HMO I-SNP) plan with a $90 copay, and no coinsurance. Urgently Needed Services are covered with 20% coinsurance and no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Routine Chiropractic Care has a $30 copay and 20% coinsurance, Physician Specialist Services have a $35 copay, Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services have 20% coinsurance, Physical Therapy and Speech-Language Pathology Services have 5% coinsurance, and Additional Telehealth Benefits have 0-20% coinsurance.
Preventive Services See details
Preventive Services are covered by the PruittHealth Premier (HMO I-SNP) plan, with some services not covered including Annual Physical Exams, Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, 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. Other covered services include Medicare-covered Zero Dollar Preventive Services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20%, and Fitting/Evaluation for Hearing Aid with no coinsurance. Prescription hearing aids are covered up to $4,000 every two years, but prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The PruittHealth Premier (HMO I-SNP) plan covers vision services, including routine eye exams with a 20% coinsurance. The plan also covers eyewear, with a combined maximum of $300.00 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PruittHealth Premier (HMO I-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, both with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PruittHealth Premier (HMO I-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items, with a maximum benefit of $105.00 every month, but does not cover 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, or Self-Directed Personal Assistance Services.
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