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American Health Advantage of Texas (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for American Health Advantage of Texas (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on American Health Advantage of Texas (HMO I-SNP) in 2026, please refer to our full plan details page.
American Health Advantage of Texas (HMO I-SNP) is a HMO I-SNP plan offered by Mitchell Family Office available for enrollment in 2025 to people living in Northeast Texas and Lubbock County. This plan received an overall rating of 2.5 out of 5 stars in 2026.
It's important to know that American Health Advantage of Texas (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:
American Health Advantage of Texas (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 American Health Advantage of Texas (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 American Health Advantage of Texas (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 American Health Advantage of Texas (HMO I-SNP) Medicare plan features an annual prescription drug deductible of $615. Before the plan begins to pay its share for your covered medications, you will need to meet this deductible amount. Because specific drug coverage tier details and copayments are not available, you should verify how your specific prescriptions are classified to understand your out-of-pocket costs. Knowing your drug deductible is a crucial step in evaluating whether the American Health Advantage of Texas (HMO I-SNP) fits your healthcare budget. For individuals looking to manage their prescription costs, keeping this $615 deductible in mind will help you plan your annual medical expenses. Be sure to contact the plan provider directly to confirm how your specific medications are covered under this plan.
Additional Benefits
The American Health Advantage of Texas (HMO I-SNP) offers comprehensive coverage for essential medical needs, with many core services requiring no copay and a standard 20% coinsurance. Primary care visits, telehealth, home health care, and skilled nursing facility stays for up to 100 days are available with no copay and no coinsurance. Outpatient hospital care, emergency services, and dialysis are also covered with no copay, though they do require a 20% coinsurance. For supplemental benefits, the plan features routine hearing and vision coverage, including a $350 yearly allowance for eyewear and up to $500 per ear annually for prescription hearing aids with no copay. Additionally, members can access up to 36 free one-way transportation trips per year to health-related locations, though routine dental care and over-the-counter items are not covered. This plan is designed to eliminate upfront copays for most services, relying instead on coinsurance for specialized and diagnostic care.
Inpatient Hospital See details
American Health Advantage of Texas (HMO I-SNP) partially covers inpatient acute and psychiatric hospital services, which require prior authorization and charge Medicare-defined copays with no coinsurance. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
American Health Advantage of Texas (HMO I-SNP) covers outpatient services with no copay and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for hospital and ambulatory surgical services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by American Health Advantage of Texas (HMO I-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
American Health Advantage of Texas (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 for up to 36 one-way trips per year to any health-related location, though transportation to plan-approved health-related locations is not covered.
Emergency Services See details
Emergency services under the American Health Advantage of Texas (HMO I-SNP) are covered with a 20% coinsurance and no copay, with the coinsurance waived if you are admitted to the hospital within one day. Urgently needed services also feature a 20% coinsurance and no copay, while worldwide emergency, urgent, and transportation services are not covered.
Primary Care See details
American Health Advantage of Texas (HMO I-SNP) offers primary care physician services, telehealth, and opioid treatment with no copay and no coinsurance, while chiropractic services are not covered in practice. Specialist visits, mental health, psychiatric, podiatry, and therapy services are covered with no copay and a coinsurance ranging from 0% to 20%.
Preventive Services See details
Preventive Services are partially covered by American Health Advantage of Texas (HMO I-SNP) with no copays and no coinsurance for covered care, including kidney disease education, glaucoma screenings, diabetes training, and in-home support. However, the plan does not cover annual physical exams, health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, caregiver support, smoking cessation, fitness benefits, enhanced disease management, telemonitoring, remote access, home safety modifications, or counseling.
Hearing Services See details
American Health Advantage of Texas (HMO I-SNP) partially covers hearing services with no deductible, offering one annual routine hearing exam with a 20% coinsurance and no copay, alongside unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC devices and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by American Health Advantage of Texas (HMO I-SNP), as other eye exam services are not covered. Covered benefits include one annual routine eye exam and contact lenses with no copay and a 20% coinsurance, as well as eyeglasses, lenses, frames, and upgrades with no copay, no coinsurance, and a $350 yearly limit.
Dental Services See details
American Health Advantage of Texas (HMO I-SNP) provides partial coverage for dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride treatments, and orthodontic services, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by American Health Advantage of Texas (HMO I-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the American Health Advantage of Texas (HMO I-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
American Health Advantage of Texas (HMO I-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by American Health Advantage of Texas (HMO I-SNP) with prior authorization. Diagnostic procedures and tests require a copayment and a minimum 20% coinsurance, while lab services and all radiological services—including X-rays—have no copay but require coinsurance, with a minimum 20% coinsurance on radiological services.
Home Health Services See details
American Health Advantage of Texas (HMO I-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by American Health Advantage of Texas (HMO I-SNP) with no copay, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by American Health Advantage of Texas (HMO I-SNP) for days 1 through 100 with no copay and no coinsurance, though prior authorization is required. This benefit does not require 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 not covered under the American Health Advantage of Texas (HMO I-SNP), as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage. Because these benefits are not covered, there are no copays or coinsurance available, and members must pay the full cost out of pocket.
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